Remote Health Policy & Implementation Lead

Intermountain Healthcare Inc.; Boston (MA); Remote; USD 43,000 - 67,000; Full time

Job summary

Intermountain Health seeks a Policy Lead to develop and implement health plan policies, shaping adjudication rules, benefit coverage, and provider reimbursement schedules. The role bridges policy concepts with operational practice across Select Health.

The ideal candidate will drive policy research, manage cross-functional implementations, and stay current with regulatory changes to ensure accurate benefit quoting and adjudication.

Qualifications

• Four years of policy experience.
• Two years in a medical benefits or insurance setting.
• Experience managing projects with strong interpersonal and organizational skills and the ability to perform under stress and to meet deadlines.
• Excellent oral, written, and interpersonal communication skills.
• Intermediate skills in computer-based word processing and spreadsheets.
• Bachelor's Degree in a business or healthcare related field.
• Four years of project management experience in a regulatory or insurance setting.
• Demonstrated intermediate knowledge with claims adjudication systems.
• Strong organizational, data gathering, and data analysis skills.
• Excellent problem solving, negotiation, and process improvement skills.
• Experience with policy, research, operations or analytics within a pharmacy or PBM setting.
• Experience with medication-centric utilization management or formulary management platforms and applications (including knowledge of pharmacy benefit configuration and/or claims adjudication).
• Familiarity with regulatory and industry standards (such as NCPDP) and demonstrated understanding of formulary and benefit design, prior authorization, step therapy, quantity limit, and other drug utilization rules

Responsibilities

• Leads the research process from policy development to implementation.
• Develops policies aligned with goals and strategies and assesses impact.
• Presents recommendations and answers questions on analysis and implementation.
• Oversees implementation of policy/product changes with an implementation team.
• Provides support and acts as a resource for policy projects.
• Stays current on policy changes and benefit quoting.
• Oversees coding review process and determines coverage on codes.
• Champions initiatives for policy changes.
• Participates in committees to ensure consistent policy development.
• Assists in policy-related product development and analytics tasks

Skills

Health Care Regulation

Communication

Project Management

Decision Making

Attention to Detail

Analytical Thinking

People Management

Cultivates Necessary Relationships

Initiative

Accountability

Education

Bachelor's Degree in a business or healthcare related field

Four years of project management experience in a regulatory or insurance setting

Tools

Claims adjudication systems

Job description

Intermountain Health seeks a Policy Lead to develop and implement health plan policies, shaping adjudication rules, benefit coverage, and provider reimbursement schedules. The role bridges policy concepts with operational practice across Select Health.

The ideal candidate will drive policy research, manage cross-functional implementations, and stay current with regulatory changes to ensure accurate benefit quoting and adjudication.