Job Details

A company is looking for a Medical Policy Specialist II.Key ResponsibilitiesDevelop and maintain medical policies in collaboration with physician staffResearch medical literature and integrate CMS directives into policy documentsCoordinate activities related to UM Vendor Delegation Programs and present policy impacts to committeesRequired QualificationsHigh School Diploma/GED required; Bachelor's degree preferred or relevant experience in lieu of degreeFive to seven years of clinical nursing or physician experience requiredThree to five years of medical claims processing experience requiredExperience in clinical research and policy development and maintenance requiredData management experience in gathering and analysis required