Anthem Medical Policy Analyst Sr. (132489) in Lubbock, Texas

/ Your Talent. Our Vision. /* At Anthem, Inc., * it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

This position can be located at any of our locations or work from a home office.

Responsible for review and research to customize MCG guidelines, analyze Anthem medical policies and clinical UM guidelines or other medical policies/clinical guidelines; coordinate with academic medical centers and medical professional specialty societies. Primary duties may include, but are not limited to:

  • Conducts structured research within defined methodologies.

  • Drafts and modifies clinical guidelines or policies using consistent template, tools and criteria.

  • Reviews new and updated codes for accuracy and consistency.

  • Researches relevant studies/information and coordinates projects.

  • Responds to internal and external requests that seek written clarification of a general or specific policy or guideline question. The response may be reiteration of an established policy, a redefinition of the current policy, or research to determine a new or revised policy.

  • Supports wave initiatives.

Qualifications:

  • Requires a BA/BS in a related field; 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.

  • Typically requires active state RN license.

  • Clinical research experience required.

  • Working knowledge of coding required.

  • Impeccable interpersonal and project management skills

  • Proven clinical research experience

  • Effective working knowledge of coding

  • Demonstrated managed care experience

  • Knowledge of Anthem medical policies and clinical UM guidelines

  • Knowledge of MCG guidelines and InterQual guidelines

Assets:

  • Nursing degree or MPH preferred.

  • Proficient in MS Office Suite: Excel required, Access preferred

Job Medical

Title: Medical Policy Analyst Sr. (132489)

Location: texas-Lubbock

Requisition ID: 132489