Behavioral Health Medical Policy Analyst

Centene Management Company LLC; Florida; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

PTO and holidays

Flexible work schedules

Job summary

Centene in Florida seeks a technical writer and policy researcher to support clinical practices, policies, guidelines, and technology assessments. You will review evidence-based criteria to aid clinical decision making and collaborate with Medical Management and Utilization Management teams.

You will help disclose medical policies to members and providers via portals and manuals, track policy updates for compliance, and contribute to legal proceedings with research support.

Qualifications

• Bachelor's degree in Medical Technology, Life Sciences or related field.
• 3+ years in healthcare, analysis, technical writing, or health administration.
• Experience writing technical publications in healthcare.

Responsibilities

• Assist with technical writing and research on clinical policies, guidelines, and technology assessments.
• Support disclosure of medical policies to members and providers via portals and manuals.
• Track timelines and updates to clinical policies to meet regulatory requirements.

Skills

Technical writing

Healthcare analysis

Policy research

Evidence-based criteria

Education

Bachelor's Degree in Medical Technology, Life Sciences or related field

RN license preferred

Job description

Position Purpose:

Assists the Chief Medical Director, Medical Management and Utilization Management Operations by providing technical writing and research associated with clinical practices, policies, guidelines, and technology assessments. Conducts research involving consistent evidence-based criteria and authorization rules in support of clinical decision making. Assists with technical assessment on new medical technologies and procedures. Assists in providing full disclosure of medical policies to members and providers through web portals and provider manuals. Provides research supplementation for the Special Investigations Unit, identifying instances of fraud, waste and abuse. Provides research and criteria to aid legal proceedings regarding clinical policy. In partnership with leadership, works with claims, configuration and claims dispute teams to ensure proper implementation of medical policy with the claims system. Tracks timelines to ensure timely updates to clinical policies to meet compliance, state, federal and accreditation requirements. Supports all annual and "as needed" updates to clinical policy, including Clinical Coverage Guidelines (CCGs), Claims Edit Guidelines (CEGs), and Clinical Practice Guidelines (CPGs). Maintains detailed knowledge of all issues concerning medical, pharmacy and behavioral health policy development and maintenance. Tracks issues concerning medical, pharmacy and behavioral health policy development and maintenance. Provides support to governing committees (e.g., Medical Policy Committee, Claims Payment Policy Committee). Participates in cross-functional teams to address key clinical policy issues facing the organization. Performs other duties as assigned.Additional Responsibilities:

Required Education:

A Bachelor's Degree in Medical Technology, Life Sciences or other related field or equivalent experience

Required Experience:

3+ years of experience in healthcare, analysis, technical writing, or health administration. Experience in writing technical publications in the healthcare field.

Licenses and Certifications:

Registered Nurse (RN) preferred

Pay Range:

$70,100.00 - $126,200.00 per year

Company Information:

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Other Compensation Details:

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity & Diversity Statement:

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Company Culture:

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.