Remote Clinical Policy & Government Programs Lead

Automatic Data Processing, Inc.; Tampa (FL); Hybride; USD 90 000 - 130 000; Plein temps

Résumé du poste

Avalon Healthcare Solutions seeks a Clinical Policy & Government Programs Specialist to support regulatory and compliance functions, including NCD/LCD enforcement and state Medicaid alignment.

The ideal candidate is a licensed Nurse Practitioner with coding credentials and strong analytical skills to translate policy into operational impact while collaborating across Operations, Legal, and Clinical teams.

Qualifications

• 7+ years of relevant experience in regulatory review, clinical policy, or health plan operations.
• U.S. NP license with active practice.
• Professional coding credential (CPC, CCS, CPC-P) or equivalent experience.
• Knowledge of CPT/HCPCS/ ICD-10 coding and Medicare/Medicaid rules.
• Excellent written and verbal communication for non-clinical audiences.

Responsabilités

• Review NCD/LCD enforcement and validate configuration and impact.
• Perform client-specific policy delta reviews and produce change reports.
• Maintain State Medicaid grids and alignment with state requirements.
• Serve as primary point of contact for client regulatory questions; collaborate across teams.
• Assist process improvements and special projects related to regulatory guidance.

Connaissances

Analytical skills

Policy interpretation

Communication

Formation

BSN/MSN

Outils

JIRA

SharePoint

SQL

Description du poste

Avalon Healthcare Solutions seeks a Clinical Policy & Government Programs Specialist to support regulatory and compliance functions, including NCD/LCD enforcement and state Medicaid alignment.

The ideal candidate is a licensed Nurse Practitioner with coding credentials and strong analytical skills to translate policy into operational impact while collaborating across Operations, Legal, and Clinical teams.