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Medical Policy Analyst - Contract

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. By conducting evidence-based research and analyzing emerging and existing medical technologies, the analyst ensures members receive optimal health care in a cost-effective manner. The role involves achieving credibility within the provider community by continuously improving research methodologies and incorporating stakeholder consultation, when appropriate, in the decision-making process.

Responsibilities

+ Stay informed about new treatments and emerging technologies through independent reading of research materials, trade journals, and other pertinent literature.

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

+ Analyze limitations of research and strength of evidence, interpret and summarize findings for internal and external stakeholders.

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

+ Ensure recommendations align with corporate policy positions and benefit and provider reimbursement strategies.

+ Create and document clear and concise evidence-based medical policies, ensuring payment outcomes reflect policy intent.

+ Present recommendations to the medical policy development committee for policy position and administration.

+ Review and update medical policy content 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 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 and make evidence-based recommendations.

+ Strong verbal and written communication skills, effectively delivering presentations.

+ Success in roles requiring strong time management skills, prioritizing effectively.

+ Self-starter who works well independently and collaboratively with internal teams.

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

Additional Skills & Qualifications

+ Prior medical criteria research and development experience.

+ Knowledge of utilization management and understanding of how medical criteria is utilized.

Work Environment

This position offers a 100% remote work environment. It is a 3-month contract position designed to cover a current employee who is out on leave. The role is part of the Medical Policy team.

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 30, 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.