RN Review Analyst (Medical Policy)/Hybrid Role

ZipRecruiter; Detroit (MI); On-site; USD 70,000 - 90,000; Full time

Job summary

A dynamic healthcare organization is seeking a skilled Medical Policy Specialist to join their team. This role involves ensuring medical policies are evidence-based and compliant with regulations. The ideal candidate will have a strong nursing background, excellent communication skills, and expertise in Medicare and medical policy analysis, contributing to high-quality patient care and organizational goals.

Qualifications

• Experience in developing and analyzing medical policies.
• Strong foundation in medical coding and CMS regulations.
• Ability to communicate complex medical concepts clearly.

Responsibilities

• Review and maintain medical policies and procedures.
• Respond to internal stakeholder queries on medical coding.
• Conduct research and analyze data for policy development.

Skills

Policy development

Medical knowledge

Health Insurance experience

Writing and communication skills

Research and analytical skills

Attention to detail

Education

Bachelor's degree in nursing

Master's in Nursing or related field

Current RN Licensure

Tools

Microsoft Office

Job description

Job DescriptionJob Description

Duration: 6 months to begin with

Will this position be required to work onsite for any reason at any time? YES

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/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.

Skills/Experience – Optional but 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

Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of , , , , , , , non-disqualifying physical or mental , , veteran status or any other bCompany DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of , , , , , , , non-disqualifying physical or mental , , veteran status or any other b