Magellan Health Job - 44810467 | CareerArc
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Company: Magellan Health
Location: Maryland Heights, MO
Career Level: Hourly
Industries: Government, Nonprofit, Education

Description

Oversees clinical guideline review process end to end, responsible for scheduling, tracking, research and policy development, copy editing, formatting, creating and maintaining quality and compliance documents to meet accreditation requirements, supports other departments on research, guideline retrieval as needed, provides support to team to ensure deadlines are met

Responsible for the development, approval, and maintenance of Utilization Management process documents to ensure compliance with legislative and accreditation requirements. Adheres to procedures, designated roles and responsibilities as outlined in the National Utilization Program Description.
  • Develops and customizes UM Process documents (Standard Operating Procedures (SOPs), Job Aids (JAs)) according to utilization management.
  • Provides oversight of the use of appropriate process documents and review requests for new or modifications to existing document templates.
  • Reviews clinical policy submissions under our UM licensure submissions.
  • Updates clinical process documents as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segments.
  • Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation and avoidance of Corrective Action Plans.
  • Researches state regulatory requirements for clinical policies using online technology and research tools.
  • Assists in facilitation of cross-departmental review process of policy/provider manual.
  • Assists in cross-departmental development and production of policy/protocol material.
  • Provides technical support and assistance to staff and departments in creation and writing of policy.
  • Works cooperatively with Training Department to develop and deliver policy-related training for staff and providers.

Other Job Requirements

Responsibilities

4+ years of healthcare industry experience.
2+ years of experience with authorization correspondence, ensuring compliance with state/federal contractual requirements.
Bachelor's degree preferred but consideration for 4 or more additional years of experience will be considered.
Analytical/problem solving skills
Strong interpersonal, consultation, organizational, tracking and follow-up skills.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Possesses excellent verbal and written communication skills.
Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS)].

General Job Information

Title

Medical Policy Researcher and Writer (REMOTE)

Grade

24

Work Experience - Required

Compliance, Healthcare

Work Experience - Preferred

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelors

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$58,440

Salary Maximum:

$93,500

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.


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