Clinical Planning and Policy Analyst (Full-time Remote, NC Based)
The Clinical Planning and Policy Analyst is responsible for supporting the policy analysis, writing and research activities by identifying, obtaining, organizing and analyzing quantitative and qualitative data, reviewing academic and professional literature and gathering information from multiple sources on cost, utilization, quality and access to health care services. This role is pivotal in shaping healthcare policies that address critical challenges and promote equitable and efficient healthcare delivery. The position requires strong analytical, communication and management skills. Additionally this position supports documents management activities within the Clinical Planning and Policy team.
This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.
Responsibilities & Duties
Medical Policy and Clinical Practice Guidelines Development
• Conducts qualitative research informed by NC expansion to Medicaid and designs medical necessity criteria to ensure medically appropriate services as outlined by the member’s benefit package
• Regularly consumes industry and policy specific news to incorporate current trends into research and analysis and communicates relevant changes to Alliance’s internal and external stakeholders
• Assists in reviewing state developed clinical coverage policies, facilitates internal discussion and feedback during public comments periods, and collaborates closely with the Waiver Manager in submitting the feedback to the regulators
• Facilitates activities related to the Medical Policy Committee meetings including meeting materials development, action items monitoring and dissemination of adopted Clinical Coverage Policies through the established channels
• Under the guidance of the Program Manager and other clinical leadership, assists the department with research and all other related tasks for clinical practice guidelines aligned with industry standards
Communication and Support
• Serves as a resource for medical policy- related questions and issues and provides technical advice and assistance to staff regarding new medical policies and clinical coverage guidelines
• Develops and implements workforce supports and trainings related to medical policies and related topics
• Acts as the department liaison with the internal Communication team and other stakeholders as appropriately to assure proper internal and external communication for medical policies and related documentation
Project Management
• Serves as the the project manager for the overall activities related to medical policies, Medical Policy Committee and other committees as assigned
• Develops and implements adequate work plans for project improvement activities related to medical policies and clinical practice guidelines
Document Management
• Support the overall activities related to standardized documents management within the Clinical Planning and Policy portfolio (policies, procedures and other standardized documents)
• Assists with the development, upload, upkeep and organization of diverse content sources within the Clinical Operations knowledge repository
• Develops, implements and follows strategies that drive content accuracy and quality, ensuring that sources are up-to-date and trustworthy
• Other duties as assigned
Minimum Requirements
Education & Experience
Required:
Bachelor’s degree in health policy, health services research, social science or a related field and three (3) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Preferred:
Master’s degree in health policy, health services research, social science or a related field and five (5) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Lean Six Sigma certification preferred
Knowledge, Skills, & Abilities
• Extensive experience evaluating, analyzing, researching, and developing health care services, policies, and programs
• Experience in working in health policy topics, Medicaid, Medicare, and commercial insurance medical necessity guidelines, and working knowledge of integrated health care systems
• Demonstrated analytical skills, natural problem solver
• Ability to highlight key insights within a complex set of data, synthesize large amounts of information, and then clearly explain these insights to various stakeholders
• Comfortable working under pressure and tight deadlines in a fast-paced environment
• Excellent interpersonal skills, especially ability to interface effectively with stakeholders of varying disciplines, background, and expertise
Employment for this position is contingent upon a satisfactory background check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.
Salary Range
$60,234-$76,799/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility
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This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.
Responsibilities & Duties
Medical Policy and Clinical Practice Guidelines Development
• Conducts qualitative research informed by NC expansion to Medicaid and designs medical necessity criteria to ensure medically appropriate services as outlined by the member’s benefit package
• Regularly consumes industry and policy specific news to incorporate current trends into research and analysis and communicates relevant changes to Alliance’s internal and external stakeholders
• Assists in reviewing state developed clinical coverage policies, facilitates internal discussion and feedback during public comments periods, and collaborates closely with the Waiver Manager in submitting the feedback to the regulators
• Facilitates activities related to the Medical Policy Committee meetings including meeting materials development, action items monitoring and dissemination of adopted Clinical Coverage Policies through the established channels
• Under the guidance of the Program Manager and other clinical leadership, assists the department with research and all other related tasks for clinical practice guidelines aligned with industry standards
Communication and Support
• Serves as a resource for medical policy- related questions and issues and provides technical advice and assistance to staff regarding new medical policies and clinical coverage guidelines
• Develops and implements workforce supports and trainings related to medical policies and related topics
• Acts as the department liaison with the internal Communication team and other stakeholders as appropriately to assure proper internal and external communication for medical policies and related documentation
Project Management
• Serves as the the project manager for the overall activities related to medical policies, Medical Policy Committee and other committees as assigned
• Develops and implements adequate work plans for project improvement activities related to medical policies and clinical practice guidelines
Document Management
• Support the overall activities related to standardized documents management within the Clinical Planning and Policy portfolio (policies, procedures and other standardized documents)
• Assists with the development, upload, upkeep and organization of diverse content sources within the Clinical Operations knowledge repository
• Develops, implements and follows strategies that drive content accuracy and quality, ensuring that sources are up-to-date and trustworthy
• Other duties as assigned
Minimum Requirements
Education & Experience
Required:
Bachelor’s degree in health policy, health services research, social science or a related field and three (3) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Preferred:
Master’s degree in health policy, health services research, social science or a related field and five (5) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Lean Six Sigma certification preferred
Knowledge, Skills, & Abilities
• Extensive experience evaluating, analyzing, researching, and developing health care services, policies, and programs
• Experience in working in health policy topics, Medicaid, Medicare, and commercial insurance medical necessity guidelines, and working knowledge of integrated health care systems
• Demonstrated analytical skills, natural problem solver
• Ability to highlight key insights within a complex set of data, synthesize large amounts of information, and then clearly explain these insights to various stakeholders
• Comfortable working under pressure and tight deadlines in a fast-paced environment
• Excellent interpersonal skills, especially ability to interface effectively with stakeholders of varying disciplines, background, and expertise
Employment for this position is contingent upon a satisfactory background check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.
Salary Range
$60,234-$76,799/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility
Apply tot his job
Apply To this Job