Manager Medical Policy *Remote*

Providence; Portland (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider is seeking a Medical Policy Manager to oversee policy development and ensure compliance across operations. This remote role requires a Bachelor's and Master's degree, along with substantial leadership and healthcare policy experience. The ideal candidate will manage cost-savings targets and maintain strategic relationships. Join a comprehensive benefits package, including retirement plan and health benefits.

Benefits

Comprehensive benefits package

Retirement plan with employer matching

Health benefits

Time-off benefits

Qualifications

• 5+ years in healthcare policy research and development, preferably in a payer setting.
• 5+ years of leadership experience.
• 3+ years of program and project management experience.
• 3+ years experience in data analytics.

Responsibilities

• Manage and supervise all medical policy development and updates.
• Coordinate and direct the policy life cycle ensuring best practices.
• Demonstrate management of cost-savings targets.
• Build and maintain strategic internal and external relationships.

Skills

Healthcare policy research

Leadership

Program management

Data analytics

Regulatory compliance

Education

Bachelor's Degree in Nursing or related field

Master's Degree in Healthcare Administration or Public Health

Job description

Overview

Providence Health Plan is seeking a Medical Policy Manager to lead the management and supervision of medical policy development, quality, implementation, publication, and routine updates. The Policy Manager will coordinate and direct all aspects of the policy life cycle and ensure coding, regulatory, legal, operational, and evidence-based best practices are maintained and documented across all Policy Teams. The role requires demonstrated management of care savings targets related to policy implementation with positive ROI and direct oversight of Master’s and PhD-level Medical Policy Analysts, Policy Coordinators, and other caregivers as needed. The Medical Policy Manager will build and maintain strategic internal and external relationships for administration and operationalization of medical policies across all lines of business, clients, and business partners.

Remote eligibility Providence Health Plan welcomes 100% remote work for applicants residing in the following states:

• Washington
• Oregon
• California

Location Remote (states listed above)

Responsibilities

• Manage and supervise all medical policy development, quality, implementation, publication, and routine updates.
• Coordinate, manage, and direct all aspects of the Plan\'s policy life cycle; ensure coding, regulatory, legal, operational, and evidence-based best practices are maintained and documented across all Policy Teams.
• Demonstrate management of cost-savings targets related to policy implementation with positive ROI (target of +$7 million annually).
• Direct reports including Master\'s and PhD-level Medical Policy Analysts, Policy Coordinators, and other caregivers as required.
• Build and maintain strategic internal and external relationships related to administration and operationalization of medical policies for all lines of business, clients, and business partners.

Qualifications

• Required: Bachelor\'s Degree in Nursing or other clinical/healthcare field.
• Required: Master\'s Degree in Healthcare Administration or Public Health.
• Required: 5 years related experience in healthcare policy research and development (preferable in a payer setting).
• Required: 5 years leadership experience.
• Required: 3 years program management and project management experience.
• Required: 3 years experience with data analytics and evaluation.
• Preferred: 3 years experience with CMS, Medicaid, and state regulatory requirements and quality accreditation bodies (e.g., NCQA).

Salary and Benefits

• Salary ranges are listed by location in the posting.
• Providence offers a comprehensive benefits package including retirement plan with employer matching, health benefits, life and disability insurance, time-off benefits, voluntary benefits, and well-being resources. Learn more at providence.jobs/benefits.

Equal Opportunity Providence is an Equal Opportunity Employer. We are committed to creating an inclusive workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran status, religion, age, national origin, sexual orientation or identity, or any other basis prohibited by law.