Remote Clinical Policy Architect, Routine Testing

Avalon Healthcare Solutions; Tampa (FL); Hybrid; USD 90,000 - 140,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Clinical Policy Development Analyst to identify and develop new evidence-based policies for Routine Test Management. You will monitor laboratory testing developments, evaluate clinical evidence and guidance, and draft policies for clinical review and approval.

The role coordinates with Product, Coding & Translation, and claims-editing teams to implement policies, with remote work eligibility and quarterly travel to our Tampa office.

Qualifications

• Ability to evaluate clinical literature and translate evidence into policy language.
• Familiarity with diagnostic testing, medical necessity, and health plan coverage policies.
• Strong research, analytical, writing, and documentation skills.
• Ability to manage multiple policy-development projects across cross-functional teams.

Responsibilities

• Research emerging laboratory tests, technologies, guidelines, and payer policies.
• Identify opportunities for new routine testing policies based on evidence and market need.
• Review peer-reviewed literature, CMS guidance, and professional society standards.
• Draft policies defining scope, medical necessity, coverage, exclusions, and references.
• Present policy recommendations for clinical review and publication.
• Review policy library for gaps and opportunities to expand or consolidate.
• Maintain organized research, citations, and version-controlled documentation.
• Collaborate with Product, Scientific Affairs, Coding & Translation, and claims-editing teams.
• Use approved AI tools to support research while validating outputs against sources.

Skills

Literature evaluation

Policy familiarity

Research & writing

Project management

Education

Advanced degree

Job description

Avalon Healthcare Solutions is seeking a Clinical Policy Development Analyst to identify and develop new evidence-based policies for Routine Test Management. You will monitor laboratory testing developments, evaluate clinical evidence and guidance, and draft policies for clinical review and approval.

The role coordinates with Product, Coding & Translation, and claims-editing teams to implement policies, with remote work eligibility and quarterly travel to our Tampa office.