Providence St. Joseph Health is calling a Medical Policy Research Analyst to our location in Beaverton, OR.
In this position you will have the following responsibilities: • Responsible for developing, writing, and updating medical policies in a timely fashion to meet compliance deadlines. • Assesses new and existing technologies through critical appraisal of the current evidence-based literature, clinical practice guidelines, and best practices as they relate to utilization management. • Work closely with PHP Medical Directors to formulate and recommend medical policy criteria, which is consistent with the current scientific evidence and standards of care. • Investigates and considers member benefits, provider network contracts, regulatory and compliance requirements and claims and medical management systems configuration to assure policies can be administered in-line with these business areas. • Analyzes and interprets utilization data to inform decisions regarding utilization management initiatives and related cost savings. • Prepares and presents evidence-based assessment summaries on specific health care service topics to inform business decisions.
Qualifications: Required qualifications for this position include: • Master’s degree in a health science related field (e.g. nursing, pharmacy, public health, epidemiology, biostatistics, genetics, behavioral health), or, current licensure or professional certification (e.g., RN or PA). • Three years of clinical or clinical research experience. • Two years’ experience developing and drafting medical policies and assessing medical technologies. • Ability to work independently on projects and complex tasks. • Strong critical thinking abilities and attention to detail. • Ability to compile information from a variety of resources (databases, websites, stakeholder feedback, benefits, contracts, etc.) to form policy assessment summaries, formulate policy recommendations, and construct succinct policy criteria. • Strong ability to verbally present research findings and recommendations at committee meetings for approval. • Knowledge of policies and procedures of Medicare, Medicaid, and health care policy. • Familiarity with CPT, ICD and HCPCS coding for medical technologies, procedures, and services. • In-depth knowledge of a majority of the following: anatomy and physiology disease processes, medical terminology, genetics, interpretation, application and impact of medical policies, and utilization management. • Experience in collecting, critically evaluating, and summarizing information from the available scientific literature, clinical practice guidelines, and other relevant sources. • Ability to provide staff with in-service trainings related to new or revised medical policies. • Proficient computer skills (Microsoft Office, Excel, Access, PPT, Lync etc.).
Preferred qualifications for this position include: • Health plan experience. • Medical coding experience.
About Providence in Oregon As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details http://www.providenceiscalling.jobs/rewards-benefits/
Our Mission As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
About Us Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
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