RN Review Analyst (Medical Policy Analyst)

Randstad (Schweiz) AG; Detroit (MI); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A leading company in health insurance is seeking a skilled RN Review Analyst to ensure medical policies are aligned with clinical practices and CMS standards. The successful candidate will leverage their expertise in policy development and health insurance to enhance patient care. This hybrid role offers opportunities for professional growth through a 6-7 month contract, with a chance for extension or conversion to permanent employment.

Qualifications

• RN with current licensure and strong background in medical policy.
• Experience in health insurance and CMS Medicare regulations.
• Excellent writing, research and analytical skills.

Responsibilities

• Review and maintain medical policies to ensure compliance with CMS regulations.
• Respond to inquiries regarding medical policy and coding matters.
• Collaborate with stakeholders to develop and improve policies.

Skills

Policy development and analysis

Medical knowledge

Health Insurance experience

Strong writing and communication skills

Research and analytical skills

Attention to detail

Education

Bachelor’s degree in nursing

Master’s in Nursing or related field

Tools

Microsoft Office

Job description

Job Title: RN Review Analyst (Medical Policy Analyst)

Client: Managed Care Organization/ Health Insurance

Location: Detroit, MI – HYBRID, once a week onsite in office.

Target Contract: 6-7 months (high potential to extend or convert to permanent)

Engagement Description –

We are seeking a highly skilled and experienced Registered Nurse (RN) to join our team as a Medical Policy Specialist. As a key member of our team, you will play a critical role in reviewing and maintaining our medical policies and procedures to ensure they are grounded in scientific evidence, aligned with professional guidelines, and compliant with CMS regulations. Your expertise will help us uphold our organization's mission and goals, while also supporting our commitment to delivering high-quality patient care. This position will include responding to questions from internal stakeholders on medical policy and coding matters.

Top 3 Required Skills/Experience –

• Policy development and analysis experience: The ideal candidate should have experience in developing, analyzing, and interpreting medical policies, procedures, and guidelines. They should be able to identify areas for improvement and update policies accordingly.
• Medical knowledge and background: A strong foundation in medical terminology, medical coding and billing, CMS Medicare regulations, and clinical practices are necessary.
• Health Insurance experience: Must have Medicare Advantage experience working for a health insurance provider. Utilization Management experience is a plus.
  
  

Required Skills

Required Skills/Experience – The rest of the required skills/experience. Include:

• Strong writing and communication skills - The ability to write clear, concise, and accurate policies and procedures is essential. The writer should be able to communicate complex medical concepts in a straightforward and accessible way.
• Research and analytical skills: The ability to conduct research, analyze data, and draw conclusions to inform policy development is essential. The writer should be able to stay up-to-date with industry trends, best practices, and emerging issues.
• Attention to detail and organizational skills: Medical policy writers must be meticulous and organized, with the ability to manage multiple projects and deadlines. They should be able to prioritize tasks, maintain accurate records, and ensure version control.
  
  

Preferred Skills

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Technical Skills: Proficiency in Microsoft Office, particularly Word, and experience with content management systems, document management software, or other relevant tools are necessary.
• Collaboration and stakeholder management: The writer should be able to work effectively with various stakeholders, including healthcare professionals, administrators, and other subject matter experts, to gather input and feedback on policies.
• Prepare and format documents according to industry standards, journal guidelines, and client specifications, including manuscript formatting, reference formatting, and document styling, to facilitate submission and publication.
• Review and revise draft documents for content accuracy, clarity, coherence, and consistency, incorporating feedback from subject matter experts, project stakeholders, and regulatory reviewers to ensure document quality and compliance with requirements.
  
  

Education/Certifications – Include

• Bachelor’s degree in nursing minimum, prefer Master’s in Nursing or related field
• Current RN Licensure
  
  

Ready to make an impact? Apply now and let’s grow together!