Manager Medical Policy
Independence Blue Cross - Philadelphia, PA

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About Our Company Independence Blue Cross is a pacesetter. With a dynamic commitment to innovation, the finest technology and a strong grounding in service to our community, we succeed by providing our people with an environment in which they can believe and thrive. Voted one of the best places to work in Pennsylvania four years in a row, Independence Blue Cross is moving forward, empowering change and defining excellence within the healthcare insurance industry. Job Summary Responsibilities Summary: The Manager, Medical Policy is responsible for the content planning, production, and quality of evidence-based coverage policies and other content on drugs, devices, procedures, and care processes that apply to all Independence Blue Cross Family of Company lines of business. The Manager, Medical Policy will be responsible for supervision of clinical staff and coordinate activities with other departmental groups. The Manager Medical Policy will report to the Director, Medical & Claim Payment Policy and will coordinate and work closely with other department management staff. DUTIES AND RESPONSIBILITIES: 1. Manages the activities of the Medical Policy Unit. 2. Makes recommendations for personnel regarding employment, performance appraisals and salary changes. 3. Manages the development and maintenance of Medical Policy Bulletins including coordination of associated activities with Claim Payment Policy, Policy Analysis & Enforcement, and Policy Communication groups. 4. Develops and maintains internal operating policies and procedures for all Unit functions. 5. Assigns and prioritizes work, ensures the accuracy, timeliness and integrity of work products and ensures staff has the resources needed to satisfactorily execute assignments. 6. Serves as a resource and provides subject matter expertise to Company associates for Medical Policy matters. 7. Oversees medical consultant review process as well as consultant agreements and contracts. 8. Chairs and/or participates in cross-functional work groups representing Medical Policy and/or Claim Payment Policy Department. 9. Establishes and maintains Unit operating and capital budgets. 10. Responsible for monthly unit reporting and budgeting of baseline and project cost centers. 11. Responsible for all additional related duties as assigned.
EDUCATION AND EXPERIENCE: Bachelors Degree and current license in clinical healthcare discipline. Graduate Degree strongly preferred. Five (5) years related work experience with two or more years in healthcare or health related field. Previous supervisory or management experience required. Strong analytic and critical thinking skills; strong medical writing skills. Working knowledge of evidence-based practice, systematic review concepts, good study design, and how to critically review technical and clinical content. Demonstrated leadership skills, including the ability to develop and lead cross functional teams. Demonstrated ability to manage technical projects with attention to detail. Proven Project Management experience. Effective interpersonal skills. Strong verbal and written communication skills. Equal Employment Opportunity Independence Blue Cross is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status. Agency Disclaimer All resumes submitted directly to an Independence Blue Cross Family of Companies employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of the Independence Blue Cross Family of Companies . Please note that no fee will be paid in the event the candidate is hired by the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.

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About this company
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Independence Blue Cross (IBC) provides health insurance and related services to some 2.2 million members in southeastern Pennsylvania and,...