Job Details

ID #2769588
State South Carolina
City Columbia
Full-time
Salary USD TBD TBD
Source Anthem
Showed 2019-10-11
Date 2019-10-12
Deadline 2019-12-10
Category Et cetera
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Medical Policy Analyst Sr. - any Anthem location or remote PS28016

South Carolina, Columbia 00000 Columbia USA

Vacancy expired!

Medical Policy Analyst Sr. - any Anthem location or remote PS28016Location: United StatesNewRequisition #: PS28016Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.Medical Policy Analyst Sr.Open to most locations including a remote arrangementThe Medical Policy Analyst Sr. will be responsible for review and research of MCG

guidelines and Anthem medical policy/clinical UM guidelines, including

customization of MCG guidelines and review of other third party criteria,

ensuring the use of valid and consistent research methodologies. Primary duties may include, but are not limited to:

Conducts structured research within defined methodologies.

Drafts and modifies policies using consistent template, tools and criteria.

Reviews new and updated codes for accuracy and consistency.

Researches relevant studies and reviews articles for development of local medical review policies and for responses to inquiries from providers.

Works with Medical Directors on development of local medical review policies.

Finalizes issues and ensures implementation of these policies.

Responds to internal and external requests that seek written clarification of a general or specific policy question.

The response may be reiteration of an established policy, a redefinition of the current policy, or research to determine a new or revised policy.

Requires a BA/BS in a related field; 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.Unrestricted and current RN or LN license is preferred. A Nursing degree or MPH is also preferred. Clinical and/or policy research experience required. Working knowledge of coding required. MCG experience is also strongly preferred.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Vacancy expired!

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