About the role
Job Summary
Provides analyst support for clinical policy review activities. Supports review and evaluation processes of existing clinical policies, proposes suggested improvements to existing policies, and facilitates research for new policy creation in alignment with market trends, changes and practices across the industry. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Reviews and evaluates existing clinical policies due for annual review.
• Determines any new evidence in areas related to existing policies including new technologies and pharmaceutical drugs.
• Proposes suggestions to improve existing clinical policies.
• Edits and amends existing policies, and writes new policy drafts, including assistance with final quality checks to ready for approval.
• Assists with final quality checks on presentations, reports, or procedural document management.
• Liaises with internal and external stakeholders to determine needs and goals of clinical policies.
• Gathers data and produces reports related to clinical policy.
• Collaborates with certified coders to ensure proper coding of policies.
• Analyzes market trends and conditions for upcoming clinical policy needs.
• Participates in group projects related to clinical and payment policies including efforts to improve department processes.
Required Qualifications
• At least 4 years of related experience, including clinical and/or literature research analysis experience in the health care industry, or equivalent combination of relevant education and experience.
• Working knowledge of clinical policies.
• Understanding of the managed care industry and market conditions.
• Strong organizational and time-management skills; ability to work independently.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, professional environment.
• Exceptional team player with a strong ability to contribute positively to a team environment with a desire to learn, grow, and empower.
• Ability to perform independent research on complex medical topics.
• Excellent and clear written and verbal communication skills.
• Knowledge and ability to operate online platforms such as Microsoft Teams, etc.
• Microsoft Office suite and Adobe Acrobat proficiency.
Preferred Qualifications
• Clinical experience (i.e. nursing, therapy, and/or social work background).
• Experience writing clinical policy.
• Knowledge of National Committee for Quality Assurance (NCQA) regulations.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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