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Job Title: Medical Policy Analyst

Job Description

The Medical Policy Analyst is responsible for the research, analysis, development, maintenance, coordination, and documentation of medical policies for all products of the company. Through evidence-based research and analysis of emerging and existing medical technologies, the analyst ensures members receive optimal healthcare in a cost-effective manner. The role requires maintaining credibility within the provider community by continuously improving research methodologies and incorporating stakeholder consultation when appropriate.

Responsibilities

+ Conduct research using standard, established sources, the Internet, and relevant peer-reviewed articles.

+ Analyze the limitations of the research and the strength of the evidence.

+ Interpret and summarize findings of research, including demographic, statistical, and scientific information, for internal and external stakeholders.

+ Collaborate and coordinate with internal and external stakeholders in the medical policy research and development process.

+ Create and document clear and concise evidence-based medical policies.

+ Present recommendations to the medical policy development committee based on analysis and interpretation of medical literature research.

+ Ensure medical policy content is reviewed and updated annually to remain current with scientific evidence and clinical practices.

+ Comply with regulatory standards, accreditation standards, and internal guidelines.

+ Review third-party medical criteria to determine the impact on current medical policies and evaluate differences.

Essential Skills

+ Completion of an accredited registered nursing program.

+ Active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota.

+ 4+ years of related health plan or clinical experience.

+ Ability to conduct research of clinical guidelines/literature/studies, draw conclusions, and make recommendations.

+ Strong verbal and written communication skills.

+ Demonstrated success in roles requiring strong time management skills.

+ Technical acumen with proficiency in Microsoft Office Suite, including Word and Excel.

Work Environment

This is a 100% remote opportunity and a 3-month contract position. The role involves working with the Medical Policy team in a remote capacity.

Pay and Benefits

The pay range for this position is $30.00 - $35.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on May 21, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] (%[email protected]) for other accommodation options.