Hybrid Medical Policy Oversight Program Manager Medical Policy Oversight Program Manager with verification

Medica’s Medical Policy Oversight Program Manager serves the critical function of working collaboratively with other departments to develop sound clinical/medical policies that reduce variation in medical and clinical decision-making. The clinical policies developed by the Program Managers are used by Medica's Utilization Management Department and Medica's Medical Directors. Clinical/medical policies are available to all network physicians and members via Medica’s websites.The Medical Policy Oversight Program Manager focuses on researching and evaluating new and changing healthcare technologies in order to interpret published clinical evidence to develop and present clinical recommendations and policies to Medica’s clinical committees comprised of Medical Directors, other clinical leadership, and practicing physicians.Key Accountabilities:

• Develop clinical policies by researching and evaluating medical literature, and by incorporating input from specialty physicians.
• Manage committees responsible for policy approval.
• Participate in assigned interdepartmental workgroups and initiatives.
• Manage cross-functional teams and clinical projects, as assigned.
• Communicate new policy determinations or policy updates to Medica stakeholders.
• Provide communication to Medica’s Marketing and Communications Department for publication on Medica’s websites.
• Arrange and compile communication for internal and external stakeholders (e.g. Utilization Management staff, providers) regarding Medica clinical/medical policies, standards of care, and medical literature.

Qualifications:

• Bachelor's Degree or above in a clinical science field or equivalent combination of related education and relevant work experience.
• 7+ years of related experience in scientific literature research & review and medical policy & guideline development.
• Knowledge of the principles of scientific study design.
• Knowledge working with health plan policy implementation and operations (e.g. coding, payment platforms) strongly preferred.
• Experience with facilitating groups of physicians, company leadership, and/or other interdisciplinary teams strongly preferred.
• Experience with formal presentations and/or training required.

Skills and Abilities:

• Strong technical writing and communication skills
• Research skills (internet and Medical library)
• Intermediate computer software skills including (but not limited to): Word, Excel, PowerPoint, Outlook
• Ability to research, prepare, and present diverse and sometimes obscure medical topics
• Ability to abstract and synthesize information from the scientific literature and develop into presentations and/or technology briefs
• Ability to present to clinical audiences, including internal clinical staff and external physicians
• Ability to identify ramifications, anticipate implications and identify solutions of medical policy determinations affecting other areas of the organization
• Ability to be self-directed, and independently prioritize tasks to meet deadlines
• Ability to multi-task
• Collaborative problem solving skills
• Process design and/or project management skills
• Must demonstrate initiative, flexibility and comfort working in teams but able to work independently and autonomously

This position is a Remote role. The employee must be located in any state in which Medica is an employer and will work remotely 100% of the time.The full salary range for this position is $67,100 - $115,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.