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Policy Development/Research Analyst- Medical Policy

  • Job ID: 409954276
  • Status: Part-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Medical Director Service
  • Location: , Work From Home Work From Home
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for a Policy Development/Research Analyst- Medical Policy to join this community as well.

UPMC Health Plan is seeking a part-time Policy Development/Research Analyst- Medical Policy. Position will report directly to the Sr. Medical Director, Medical Policy Department, while working with various Health Plan staff to manage successfully day-to-day oversight activities necessary to meet the myriad UM federal and state regulatory including CMS, PID, DHS, NCQA and regulatory compliance. 

Training/Experience in searching the medical literature and information research which allows them to create or update topic-specific Reference Sheets which incorporate systematic research of the peer-reviewed medical literature for Medical Policy Department staff.

This role is currently work-from-home and has great potential to remain remote.
 

This role is forecasted to eventually be full-time. 


Responsibilities:

  • Work directly with Sr. Medical Director and staff of for Medical Policy Department on all medical literature research. This includes monitoring existing guidelines and professional clinical practice guidelines.
  • Assist Sr. Medical Director to precept Medical students
  • Coordinates research and documentation of Medicare NCD & LCD and other government program requirements as part of new medical policy development and existing medical policy annual review compliance
  • Creation/updating of reference sheets which includes systematic research of the peer-reviewed medical literature for Medical Policy Department staff.
  • Coordinate with Departmental Project Analyst on final format of references in medical policies.
  • Represent Medical Management on the Exchange and other government program work groups
  • Assist the Medical Advisor in preparing research and documentation for the Technology & Assessment Committee (TAC) and Ethics Committees
  • Coordinate with the legal department to ensure medical management compliance with PPACA and new health insurance legislation
  • Coordinate delegated oversight for UM NCQA and regulatory compliance

Qualifications

  • Bachelor's degree required; master's degree preferred (extensive related experience will be considered.)
  • Minimum of four (4) years of experience in health care insurance. 
  • Previous administrative experience in a medical center or setting and at least seven (7) years of regulatory (DOH or PID) experience required. 
  • Training/Experience in searching the medical literature and information research which allows them to create or update topic-specific Reference Sheets which incorporate systematic research of the peer-reviewed medical literature for Medical Policy Department staff.
  • CMS, DOH, DHS or PID experience as a whole preferred
  • Demonstrated performance in meeting time-sensitive deadlines with minimal supervision.Training/
  • Experience in searching the medical literature and information research.
  • Ability to handle multiple priorities and projects in a fast-paced professional environment with minimal supervision.
  • Solid understanding of managed health care organizations required.
  • Excellent oral and written communication skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct