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CareSource · 6 hours ago

Clinical Policy Specialist

United States

Full-time

Remote

Entry, Mid Level

$54K/yr - $87K/yr

2+ years exp

CareSource is a healthcare organization providing clinical policy support through managing state submissions and ensuring compliance. The Clinical Policy Specialist I will assist in executing, monitoring, and supporting clinical policy projects while collaborating with interdisciplinary teams to achieve goals.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

Assist Clinical Policy Project Specialist to execute, monitor and support new lines of business throughout the entire clinical policy project lifecycle

Audit, monitor and prepare clinical policies for NQCA, state, and internal audits

Develop, implement, configure, and maintain decision trees, workflows, documentation and monitoring protocols to operationalize clinical policies and criteria in a timely manner

Participate in department initiatives and projects including implementation of new document management systems

Support the development and maintenance of enterprise Clinical Policy programs (i.e., policy assessments, department newsletter, network notification communications)

Collaborate with interdisciplinary team members to achieve team goals

Participate in risk assessment and continuous improvement activities, as needed

Follow Workfront procedures to coordinate and implement changes ensuring regulatory, compliance, and business goals are met

Ensure timely submission, accurate documentation, and tracking of all Communication Request Forms and network notifications for clinical policies to be published on external websites

Monitor the CareSource public website to ensure policies are accurately published and accessible

Document and track state submissions and approvals, keeping consistent communication with Clinical Policy team, leadership, and regulatory as necessary

Track and trend clinical policy metrics (i.e., CRF, archives, revisions) reported monthly, quarterly, end of year, and as needed

Assist with Policy Tech functions to streamline policies through the entire end-to-end process

Support the operational processes of the Clinical Policy Governance Committee (CPGC)

Create agendas, document, and store minutes and pertinent records for all assigned team meetings as necessary

Maintain and update job related internal policies and procedures applicable to Clinical Policy process and workflows

Provide coverage for both Policy Coordinator and Policy Project Specialist when needed

Perform any other job duties as requested

Qualification

Healthcare policy experienceDocumentation management systemsSharePoint managementMicrosoft WordMicrosoft ExcelPowerPoint presentationsMedical terminologyCritical thinkerDetail-orientedCommunication skillsProblem-solving skillsOrganizational skills