Nebraska Licensed Clinical Analyst

Job Summary

Serving as the senior clinical subject matter expert, the full-time Nebraska Licensed Clinical Analyst will lead medical policy development, clinical coding strategy, and complex claims configuration initiatives while working remotely from specified states.

Key responsibilities

• Lead the development and evaluation of medical policies based on clinical literature, guidelines, and regulatory requirements
• Oversee the implementation of coding updates and provide strategic guidance on claims adjudication processes
• Direct enterprise-wide projects and provide clinical consultation to leadership on complex policy issues

Required qualifications

• Current Registered Nurse (RN) license in good standing
• Bachelor's degree in Nursing (BSN) required; Master's degree preferred
• 5-7 years of progressive clinical nursing experience in a complex healthcare setting
• 3 years of experience in medical policy, utilization management, or clinical coding
• Advanced knowledge of ICD-10, CPT, HCPCS, and CMS payment methodologies