Senior Clinical Policy Research Professional
The Senior Clinical Policy Research Professional works closely with Humana's dental directors and medical directors to research, develop and maintain dental and medical coverage policies utilizing an evidence-based medicine review process.
Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:
- Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance
- Provide comprehensive verbal and written summation of research to dental directors, medical directors and leadership during policy discussion meetings and to the MCCR MCPA committees
- Perform ad hoc dental and medical research for dental directors and medical directors as needed for individual case reviews
- Perform research regarding new CPT and HCPCS codes as needed on a quarterly basis and work closely with the PAL team to address PAL codes requiring clinical coverage policy guidance
- Interdepartmental committee participation
- Collaboration with stakeholders across the organization
Please note this role will consist of working mostly independently to review large amount of clinical information to update clinical policies. The ideal candidate for this role would enjoy researching, reading and writing policies independently. Success in this role requires:
- Strong organization skills and detail orientation
- Excellent verbal and written communication skills
- Strong analytical and web navigation skills
- Self-direction with demonstrated ability to meet strict deadlines
- Strategic thinking and planning capabilities
Use your skills to make an impact
Required Qualifications
- Associate or bachelor's degree in dental hygiene or dental assisting
- Appropriate state certification or licensure as a dental assistant or dental hygienist
- 5 years or more of prior clinical experience
- Proficiency with Microsoft Office products including Word and Excel
Preferred Qualifications
- Master’s degree in health-or business-related field
- Utilization management experience (Medicare or Medicaid)
- Proven successful experience in compiling health-related research, with associated analysis and conclusions
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 06-04-2026
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Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:
- Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance
- Provide comprehensive verbal and written summation of research to dental directors, medical directors and leadership during policy discussion meetings and to the MCCR MCPA committees
- Perform ad hoc dental and medical research for dental directors and medical directors as needed for individual case reviews
- Perform research regarding new CPT and HCPCS codes as needed on a quarterly basis and work closely with the PAL team to address PAL codes requiring clinical coverage policy guidance
- Interdepartmental committee participation
- Collaboration with stakeholders across the organization
Please note this role will consist of working mostly independently to review large amount of clinical information to update clinical policies. The ideal candidate for this role would enjoy researching, reading and writing policies independently. Success in this role requires:
- Strong organization skills and detail orientation
- Excellent verbal and written communication skills
- Strong analytical and web navigation skills
- Self-direction with demonstrated ability to meet strict deadlines
- Strategic thinking and planning capabilities
Use your skills to make an impact
Required Qualifications
- Associate or bachelor's degree in dental hygiene or dental assisting
- Appropriate state certification or licensure as a dental assistant or dental hygienist
- 5 years or more of prior clinical experience
- Proficiency with Microsoft Office products including Word and Excel
Preferred Qualifications
- Master’s degree in health-or business-related field
- Utilization management experience (Medicare or Medicaid)
- Proven successful experience in compiling health-related research, with associated analysis and conclusions
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 06-04-2026
Apply tot his job
Apply To this Job