Medical Policy Analyst RN

Blue Cross and Blue Shield Association - Fargo, ND

Full-time - Mid Level

Fargo, ND

Religious, Grantmaking, Civic, Professional, and Similar Organizations

About the position

The Medical Policy Analyst is responsible for research, analysis, evaluation, and the development of medical policies. This role drives decision making regarding medical policy development, ensures policies are implemented and integrated with all systems, and organizes communication of changes to internal partners and external stakeholders.

Responsibilities

• Develops, maintains, and implements medical policies and guidelines to meet regulatory requirements for preventative benefits.
• Identifies, analyzes, and monitors industry, regulatory, technology and market-based trends that affect medical policy, health care quality, utilization studies, pre and post services, appeals and other related initiatives.
• Collaborates with key internal stakeholders to develop recommendations for benefit plan design changes and implement new code updates.
• Facilitates and participates in cross-functional workgroups to prioritize and submit project requests to appropriate vendor(s).
• Represents the division at company operational meetings and on assigned corporate projects.
• Supports and serves as a liaison to other departments for medical policy issues, questions, and implementation of policies.
• Prepares communications and reports for internal and external audiences regarding medical policy, coding, and benefit implementations.
• Prioritizes work and determines which medical policies are required for next review in order to meet regulatory requirements and contract standards.
• Provides support and back-up to the team such as assisting with appeals activities, analyzing data, maintaining processes and procedures, and preparing information for ad-hoc requests and projects.
• Utilizes expertise to identify operational improvements with new analysis/reporting capabilities, project management techniques and/or engagement approaches.

Requirements

• A Bachelor's degree in Nursing or the completion of an RN program.
• Minimum of 3 years of acute medical or clinical experience in healthcare, utilization review, medical policy review, quality management, or related experience is required.
• Experience working in a managed care/health plan organization and coding background is preferred.
• An RN license valid for work in the state of North Dakota or a compact RN license.
• Be a problem solver with the ability to research, analyze and implement medical policies and guidelines.
• Clearly communicate and collaborate with various departments, using clinical expertise to develop recommendations.

Nice-to-haves

• Experience working in a managed care/health plan organization and coding background.

Benefits

• Affordable medical, dental and vision coverage accepted throughout the United States
• Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
• Employer-paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.