New Jersey Licensed Medical Policy Specialist

Job Summary

Responsible for researching and developing medical policy, the full-time New Jersey Licensed Medical Policy Specialist will coordinate policy implementation and updates, review annual code changes, and serve as a Subject Matter Expert while working remotely.

Key responsibilities

• Review and analyze clinical and health-related technology to inform the development of medical policies
• Participate in Medical Policy Committees and advise on policy implementation in collaboration with the Medical Policy Integration team
• Maintain and update existing medical policies and coordinate activities to resolve issues identified through retrospective utilization review

Required qualifications

• High School Diploma/GED required; Bachelor's degree preferred or relevant experience in lieu of degree
• Minimum three (3) years of clinical nursing or physician experience required
• Minimum three (3) years of medical claims processing experience required
• Registered Nurse (RN) license or foreign-trained physician required
• In-depth knowledge of anatomy, physiology, and medical coding structures (CPT, ICD-9/10, HCPC) required