Medical Policy Writer

Evolent • Pierre, SD • 1w ago

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You'll Be Doing:

Put your passion where it meets purpose! We are looking for a Medical Policy Writer/Senior Policy Specialist who will be responsible for the development, approval, and maintenance of Utilization Management process documents to ensure compliance with legislative and accreditation requirements. This person will need to adhere to procedures, designated roles and responsibilities as outlined in the National Utilization Program Description.

Collaboration Opportunities:

Support and Development

Research, write, and edit UM Clinical Guidelines, through lifecycle of guideline

Collaborate with Clinical Subject Matter Experts to ensure accurate and evidence-based clinical content in Clinical Guidelines

Update clinical process documents as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Company Policy across product lines and business segments

Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation

Research and incorporate customer and state regulatory requirements into Clinical Guidelines

Collaborate with multiple internal and external Key Stakeholders on the impact of Clinical Guideline changes

Oversee Clinical Guideline Committee, schedule and facilitate committee meetings, document meeting minutes, store all meeting content

Support the Medical Policy team on other projects and tasks

Qualifications - Required and Preferred:

Bachelor degree preferred but consideration for 4 or more years experience medical writing will be considered OR Master's Degree, PhD

Medical research and/or medical writing experience

Healthcare experience 2+ years

Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product

Analytical/problem solving skills

Strong interpersonal, consultation, organizational, tracking and follow-up skills

Possesses excellent verbal and written communication skills

Ability to work collaboratively with a team and with other Key Stakeholders

Ability to work independently with flexibility, and with ownership of assigned tasks

Preferred knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Centers for Medicare and Medicaid Services (CMS)]

To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $78,000-$84,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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