Maine Licensed Medical Policy Clinician

Job Summary

A company is looking for a Health Plan Data and Medical Policy Clinician - Remote.

Key Responsibilities

• Analyze coverage, payment, and coding policies for treatments and inform stakeholders of potential impacts
• Perform data management analyses and assist in the development of clinical guidelines and standards
• Lead the Medical Policy Committee and develop evidence-based medical policies aligned with industry standards

Required Qualifications, Training, and Education

• Associate's degree in nursing; BSN preferred
• Current, unrestricted Registered Nurse licensure in Maine
• 5+ years of medical management experience in a managed care setting
• Experience with ICD10, CPT, HCPCS, and medical policy creation
• One or more Certified Professional Coder Certifications (CPC, CCS, CCA, CPMA)