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Policy Development Research Associate

  • Job ID: 239994738
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Medical Director Service
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / 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 Associate to join this community as well.

UPMC Health Plan is hiring a Full-Time Policy Development Research Associate to help support the Medical Director Service Department for its Downtown location.  This position will work Monday through Friday daylight hours.

This position will report directly to the Manager, Medical Policy in the Medical Policy Department while working primarily with the Research Analyst and Project Analyst within the Medical Policy Department, as well as Policy Authors in the Department. The goal of this job is to prepare accurate and complete regulatory and competitor policy research in policy Reference Sheets, as well as timely update of all references in medical policies (MP) and medical policy prior authorization (MP.PA) policies, produced by the Medical Policy Department.

Responsibilities:

  • Work with Research Analyst to update Reference Sheets for annual review of existing medical policies (MP) and medical policy prior authorization (MP.PA) policies, by:
    • Collating received input from regulatory compliance staff for all lines of business into the Reference Sheets. This update includes formatting of citations and insertion of pdfs within the Reference Sheets
    • Working with internal Compliance Departments for government programs, as well as commercial benefits for any necessary follow-up to input received
    • Researching/updating competitors' policies identified in the Reference Sheets.
  • For all new MP and MP.PA policies, assist Research Analyst in creating new Reference Sheets, which includes incorporating references from any previous Reference Sheets completed for Experimental & Investigational (E&I) or CompCheck research projects on the same topic.
  • Prepare all Reference Sheet updates for the ongoing CompCheck project for existing E&I List.
  • Assist Research Analyst and Policy Author on E&I monthly duty in accessing regulatory and competitors' policies for coverage queries.
  • Work with Project Analyst on updating references in all draft policies in accurate and complete manner prior to sending them on to internal departments and external agencies.
  • Spearhead implementation of reference database system from current manual process.
  • Work with Research Analyst and Project Analyst to update departmental tracking logs.

Qualifications

  • Bachelor's degree required.
  • Demonstrated performance in meeting time-sensitive deadlines with minimal supervision.
  • Ability to handle multiple priorities and projects in a fast-paced professional environment with minimal supervision.
  • Editorial experience and previous experience in managed health care organizations preferred.
  • Excellent oral and written communication skills.


UPMC is an Equal Opportunity Employer/Disability/Veteran

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At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct