Senior Health Policy Architect — Remote

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

Job summary

Intermountain Health in Murray, Utah is seeking a policy leader who will develop and implement health plan policies that shape adjudication rules, benefit design, and provider reimbursement schedules. This role bridges policy concepts with operational practice across the enterprise.

The position oversees policy changes, coordinates implementation, and provides expert input for projects requiring policy insights.

Qualifications

• Four years of policy experience.
• Two years 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.

Responsibilities

• Leads the research process which includes initial request for policy development or modification through analysis and development of recommended policy to senior management, and implementation of approved policy.
• Develops policies. Considers the fit with organizational goals and strategies, impact on organization's initiatives, long-term marketing strategies, and the amount of clinical input required to determine if the request fits the scope policy process.
• Presents recommendations, answers questions about the analysis as well as impacts and ease of implementation. Presents issues and recommendations based on findings.
• Oversees the implementation of approved policy/product changes and coordinates the efforts of an implementation team with affected management and their functional areas of responsibility.
• Provides support and acts as a resource for projects or teams needing extensive 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 proper adjudication.
• Oversees the coding review process, makes coverage and benefit determinations on each individual code.
• Champions and leads initiative 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, as well as project tracking, prioritization, and other related project management activities.

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 is seeking a policy leader who will develop and implement health plan policies that shape adjudication rules, benefit design, and provider reimbursement schedules. This role bridges policy concepts with operational practice across the enterprise.

The position oversees policy changes, coordinates implementation, and provides expert input for projects requiring policy insights.