Registered Nurse Medical Policy Manager

Job Summary

A company is looking for a Medical Policy Manager for Behavioral Health Services.

Key Responsibilities:

• Researches scientific evidence and guidelines for behavioral health services and collaborates with clinical teams to update clinical review criteria
• Reviews and documents revisions to medical policies, ensuring compliance with NCQA guidelines and regulatory requirements
• Coordinates external policy reviews and presents recommendations to the Utilization Management Committee

Required Qualifications and Education:

• Bachelor's degree in nursing or equivalent combination of education and experience
• 6 years of experience in a managed care setting, including utilization management
• Knowledge of coding essential; Certified Professional Coder (CPC) preferred
• Registered nurse with a current active license preferred; other licensed allied health care professionals considered
• 5+ years of clinical experience in behavioral health services preferred