Remote Senior Health Policy Architect

Intermountain Healthcare Inc.; Helena (MT); Remote; USD 43,000 - 68,000; Full time

Job summary

Intermountain Health in Murray, Utah, seeks an experienced Policy Specialist to lead development and implementation of health plan policies, adjudication rules, and benefit design. You will bridge policy concepts with operational practice and supervise cross-functional teams to ensure compliant, effective policy deployment.

Key responsibilities include policy research from request through analysis, presenting recommendations, guiding coding determinations, and coordinating policy changes with

Qualifications

• Four years of policy experience.
• Two years of experience in a medical benefits or insurance setting, or other related work experience to gain a good understanding of claims and eligibility issues, basic medical coding expertise, and insurance product knowledge.
• Experience managing projects that require 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 policy research from initial request through analysis and development of recommended policy.
• Develops policies, considering fit with organizational goals, initiatives, and required clinical input.
• Presents recommendations and answers questions about the analysis, impacts and implementation.
• Oversees the implementation of approved policy/product changes and coordinates an implementation team.
• Provides support and acts as a resource for projects needing input from a policy specialist.
• Stays current on changes, practices, policies, and all aspects of the business to provide accurate information about benefit quoting and adjudication.
• Oversees the coding review process, makes coverage and benefit determinations on each code.
• Champions and leads initiatives for policies requiring change.
• Participates in functional area committees to ensure consistent policy development.
• Assists in other product development activities and projects such as benefit design research, member satisfaction research and market research.

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

Job description

Intermountain Health in Murray, Utah, seeks an experienced Policy Specialist to lead development and implementation of health plan policies, adjudication rules, and benefit design. You will bridge policy concepts with operational practice and supervise cross-functional teams to ensure compliant, effective policy deployment.

Key responsibilities include policy research from request through analysis, presenting recommendations, guiding coding determinations, and coordinating policy changes with