Virginia Licensed Medical Policy RN

Job Summary

To support clinical decision-making and policy development, the full-time Virginia Licensed Medical Policy RN will conduct research on evidence-based clinical technologies, maintain clinical criteria databases, and collaborate with Medical Directors, all while working remotely with occasional travel to Virginia Beach.

Key responsibilities:

• Conduct ongoing research of clinically evidence-based technologies for medical policy and benefit development
• Maintain and review the database of clinical criteria to ensure compliance with Federal, State, and Accreditation Standards
• Perform comprehensive literature reviews and collaborate on updates to clinical guidelines and medical policies

Required qualifications:

• Bachelor's Level Degree in Nursing
• Active RN license in Virginia or Compact/Multistate
• Three years of related experience in clinical criteria coverage
• Three years of experience in Managed Care
• Knowledge of medical policy, emerging technology, and analysis of clinical literature