New Jersey Licensed Medical Policy Specialist

Job Summary

A company is looking for a Medical Policy Specialist II.

Key Responsibilities

• Develop and maintain medical policies in collaboration with physician staff
• Research medical literature and integrate CMS directives into policy documents
• Coordinate activities related to UM Vendor Delegation Programs and present policy impacts to committees

Required Qualifications

• High School Diploma/GED required; Bachelor's degree preferred or relevant experience in lieu of degree
• Five to seven years of clinical nursing or physician experience required
• Three to five years of medical claims processing experience required
• Experience in clinical research and policy development and maintenance required
• Data management experience in gathering and analysis required