RN Medical Coverage Policy Strategist

HealthPartners; BLOOMINGTON (MN); Hybrid; USD 90,000 - 120,000; Full time

Job summary

HealthPartners in Bloomington, MN seeks an RN Medical Coverage Policy Consultant to develop, review, and implement evidence-based medical policies guiding coverage decisions. The role analyzes current literature, collaborates with Claims, UM, Medical Directors, Contracts, Benefits, and Government Programs, and supports internal and external partners with policy expertise.

Hybrid onsite Tue-Thu. The incumbent will drive policy development, interpret complex clinical information, and contribute to

Qualifications

• Bachelor's degree in nursing and Minnesota RN license.
• 3-5 years of medical policy experience; 5+ healthcare experience with literature review and policy development.
• Demonstrated health plan implementation experience or knowledge of health plan operations.
• Experience with evidence-based medical coverage policies and cross-functional collaboration.

Responsibilities

• Research, identify, analyze and evaluate evidence-based scientific literature for coverage policies.
• Develop professional documents to support health plan coverage positions and present findings.
• Interpret and compare benefit coverage across Commercial, Medicare, Medicaid, and employer groups.
• Review informatics and claims data to understand volume, costs and coding implications for policy.
• Develop and revise coverage criteria policies to support policy strategy.
• Coordinate implementation plans and resolve issues across departments.
• Communicate policy interpretation and rationale to providers, members, and internal stakeholders.
• Provide staff support for committees and evolving departmental work.

Skills

Communication skills

Critical thinking

Documentation

Project management

Autonomous work

Microsoft Word

Excel

PowerPoint

Medicare knowledge

Education

Bachelor's degree in nursing

Medical coding certification (preferred)

Tools

Visio

PowerPoint

Job description

HealthPartners in Bloomington, MN seeks an RN Medical Coverage Policy Consultant to develop, review, and implement evidence-based medical policies guiding coverage decisions. The role analyzes current literature, collaborates with Claims, UM, Medical Directors, Contracts, Benefits, and Government Programs, and supports internal and external partners with policy expertise.

Hybrid onsite Tue-Thu. The incumbent will drive policy development, interpret complex clinical information, and contribute to