Wellmark - Des Moines Health Services Medical Policy Analyst (Registered Nurse) in Des Moines, Iowa
Help us lead change and transform the member experience
The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’re embarking on a journey to help our members use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.
Use your strengths as Health Services Medical Policy Analyst
In this role, you will be responsible for the research, analysis, development, maintenance, coordination, and documentation of medical policies for all products of Wellmark, Inc. Through evidence-based research and analysis of emerging and existing medical technologies, you will contribute to ensuring Wellmark's members receive optimal health care in a cost-effective manner. Medical Policy Analysts achieve credibility within the provider community by continuously improving research methodologies and incorporating stakeholder consultation, when appropriate, in the decision making process.
Our strongest candidates love to conduct research and make evidence-based decisions and recommendations. They have a knack for tracking deliverables, details, and prioritizing work effectively. Although they are independent workers, they have very strong interpersonal skills and collaborate well with others.
Completion of an accredited registered nursing program.
Active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota; individual must be licensed in the state in which they reside.
4+ years of related health plan or clinical experience.
Demonstrated ability to conduct research of clinical guidelines/literature/studies, draw conclusions and make recommendations to support evidence based decisions.
Strong verbal and written communication skills. Effectively delivers presentations to internal stakeholders and expresses complex concepts clearly and concisely.
Demonstrated success in roles requiring strong time management skills. Prioritizes effectively and manages multiple deliverables.
Self-starter who works well independently and collaboratively with internal teams; strong interpersonal skills.
Technical acumen with the ability to learn new systems quickly - e.g. Microsoft Office Suite, applications including Word and Excel.
Prior medical criteria research and development experience.
Utilization management knowledge; demonstrates understanding of how medical criteria is utilized.
a. Keep up-to-date on new treatments and maintain awareness of emerging technologies through independent reading of research, materials, trade journals, and other pertinent literature.
b. Conduct research using standard, established sources, the Internet, and relevant peer reviewed articles. Analyze the limitations of the research and the strength of the evidence. Interpret and summarize findings of the research, including demographic, statistical and scientific information, for internal and external stakeholders.
c. Collaborate and coordinate with internal medical directors, product development, provider economics, legal, etc. and external stakeholders e.g. healthcare providers, academic and scientific professionals, and national and local professional organizations in medical policy development activity. Ensure recommendation align with corporate policy positions and benefit and provider reimbursement strategies.
d. Create and document clear and concise evidence based medical policies. Policy content is written to include clear guidance to ensure payment outcomes reflect the intent of the medical policy. Present recommendations to the medical policy development committee for policy position and administration based on analysis and interpretation of medical literature research.
e. Ensure medical policy content is reviewed and researched on an annual basis at minimum and updated as needed to remain current with scientific evidence and clinical studies.
f. Serve as a consultant by gathering relevant information, integrating internal systems, and making innovative recommendations, for policy implementation.
g. Comply with regulatory standards, accreditation standards and internal guidelines remain current and consistent with the standards pertinent to the Medical policy team.
h. Other duties as assigned.
Posting Title: Health Services Medical Policy Analyst (Registered Nurse)
Requisition ID: 214638
External Company Name: Wellmark Blue Cross and Blue Shield
External Company URL: www.wellmark.com