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Medical Policy Analyst

  • Job ID: 243432771
  • 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: $26.58 to $46.02 / hour

Description

Do you have a background in genetic testing and an interest in medical policy? Are you excited by an opportunity where you can use your critical thinking abilities? UPMC Health Plan may have a role for you!

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

This role supports the Medical Policy Department in developing and communicating coverage policies for healthcare services covered by UPMC HealthPlan, ensuring the policies meet the myriad federal and state regulatory requirements including CMS, PID, DHS, and NCQA.  The Medical Policy Analyst position requires a high-energy, detail-oriented individual interested in and knowledgeable about health- and public- policy and medically necessary clinical services requested of commercial insurers, third-party administrators and Medicaid and Medicare managed care organizations.

The Analyst will engage in a full range of policy and advocacy activities through research, writing, collaboration with multiple stakeholders, and other substantive and operational activities.  The Analyst will perform comprehensive research of the competitive marketplace, including coverage policies and utilization management standards of national insurers, accountable care organizations, with particular focus on integrated payer/provider organizations and insurers competing in the local western Pennsylvania market.  Under the direction of the Senior Medical Director for Medical Policy, the Medical Policy Analyst will support the Technology Assessment Committee (TAC) by researching new technologies and presenting information to TAC and then submitting TAC recommendations to the Benefits and Reimbursement Committee.

Responsibilities:

  • Assist with research and development of medical policy materials.
  • Where necessary, assist company personnel in understanding, implementing and monitoring relevant operational requirements.
  • Monitor myriad sources for changes/updates/developments on key issues and brief company personnel as directed by Senior Medical Director.
  • Attend internal and external meetings on behalf of the Senior Medical Director regarding aspects of medical policy.
  • Perform special project assignments for the Senior Medical Director of Medical Policy as requested.

 

Qualifications

  • Master's degree in Health Care Policy or related field required or currently enrolled in Master's level program with 1 year of experience in Health Care public policy issues.
  • Genetic testing background preferred
  • Must demonstrate skill and proficiency in policy-related research.
  • Must demonstrate policy-related analytical skills and problem solving ability.
  • Excellent communication skills, verbal and in writing.
  • General knowledge of regulatory aspects of health insurance or managed care.
  • Capacity to work on multiple projects simultaneously, frequently under tight deadlines.
  • Strong organizational skills.Competency in MS Office applications (e.g., Word, Excel, PowerPoint, Outlook).


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

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