The Healthcare Technology Analyst and Medical Policy Writer, working under limited supervision, synthesizes available research to write corporate medical policies for technologies and procedures in all clinical service areas. Recommends and establishes medical policy guidelines that have a direct impact on customers, assuring only medically appropriate service are allowable and covered under the medical plan. Analyzes corporate financial data to ensure the impact of policy changes on corporate payout and impact to Company's financial trend.
• Researches and analyzes evidence based and peer reviewed clinical literature, corporate financial data and other data related to medical technologies, procedures, drugs, equipment
• Researches and develops utilization management pre-certification criteria for medical policies to be used by review, utilization and case management nurses
• Draws information from various databases and external sources to create reports that define the Company’s medical policy for coverage
• Creates summaries of findings, writes clinical summaries and develops company medical policy guidelines.
• Formulates recommendations for coverage based on all factors of evidence based data, corporate payout and impact on trend and certificate of coverage guidelines
• Collaborates with physician review of technology assessments.
• Develops and delivers educational training regarding policies to nurse review teams
• Researches questions and issues from internal physicians and nurses as they related to developed medical policies
• Supports system (SPI, PCI, RVI) edit decisions and development
• Codes changes into claims systems using national coding structure for processing accuracy and clinical appropriateness once medical policy has been established
• Serves as a liaison to business units for correct coding of claims
• Bachelor’s Degree in Life Science, Nursing or related field OR
Certificate in Professional Coding and at least three years of college credits (incumbents hired prior to 2011)
• Graduate level training in a scientific field relevant to health services research preferred
• Minimum five (5) years experience in nursing, research or related clinical which includes organizational and project management experience
• Experience in health technology assessment and evaluation preferred
• Clinical research, analytics and writing experience preferred
• Financial analytics and impact assessment experience preferred
Knowledge, skills and abilities:
• Knowledge of healthcare system and factors that affect adoption and implementation of new and emerging healthcare technologies and procedures
• Knowledge of how to appropriately reference and attribute source material
• Understanding of medical coding as it relates to diagnosis and procedures
• Strong literature searching skills and ability to synthesize complex information, a critical mind
• Strong verbal and written communication skills, including the ability to explain scientific principles concisely and accurately
• Excellent medical writing skills to write clearly and succinctly for a broad healthcare audience
• Computer literate; intermediate to advanced proficiency with Windows-based programs and applications
• Ability to quickly synthesize volumes of information on health technologies and clinical trials in wide variety of clinical areas
• Ability to analyze financial data, understand trend and formulate recommendations on coverage under the medical plan
• Attention to detail and ability to work independently, prioritize effectively, and meet deadlines
• Ability to be flexible in a fast-paced environment
• Ability to travel occasionally based on business requirements, as needed
PHYSICAL DEMANDS/WORK ENVIRONMENT:
• Normal office environment involving the use of computer and phone for research, preparation and presentation.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse and tobacco testing.
Medical Mutual of Ohio is a not-for-profit managed care company that provides health insurance products and related services to some 1.6...