Clinical Policy Specialist

Job Summary

A company in the healthcare industry is seeking a Clinical Policy Specialist to design and implement clinical policies within their product.

Position Responsibilities:

• Design and format clinical criteria across a range of medical specialty areas that meets product specifications and retains clinical accuracy
• Review healthcare policy documentation and data for discrepancies and missing information and resolve discrepancies
• Author healthcare policies including policy text, clinical indications, procedure codes, and diagnosis codes into Cohere Health's product

Required Qualifications:

• At least 2-5 years of clinical, regulatory, or scientific writing
• A Bachelors, Masters, PharmD or Ph.D. in a life science or health discipline, nursing preferred
• Experience with clinical decision-making criteria sets (e.g., Milliman, InterQual)
• Minimum of one year of experience with prior authorization activities in a utilization management organization, experienced in writing policies or patient facing content (preferred)
• Tech-savvy and detail-oriented