Job Description

Job Title: RN Review Analyst (Medical Policy Analyst)

Client: Managed Care Organization/ Health Insurance

Location: Detroit, MI – HYBRID, once a week onsite in office.

Target Contract: 6-7 months (high potential to extend or convert to permanent)

 

Engagement Description –

We are seeking a highly skilled and experienced Registered Nurse (RN) to join our team as a Medical Policy Specialist. As a key member of our team, you will play a critical role in reviewing and maintaining our medical policies and procedures to ensure they are grounded in scientific evidence, aligned with professional guidelines, and compliant with CMS regulations. Your expertise will help us uphold our organization's mission and goals, while also supporting our commitment to delivering high-quality patient care. This position will include responding to questions from internal stakeholders on medical policy and coding matters. 

Top 3 Required Skills/Experience –

• Policy development and analysis experience: The ideal candidate should have experience in developing, analyzing, and interpreting medical policies, procedures, and guidelines. They should be able to identify areas for improvement and update policies accordingly.
• Medical knowledge and background: A strong foundation in medical terminology, medical coding and billing, CMS Medicare regulations, and clinical practices are necessary.
• Health Insurance experience: Must have Medicare Advantage experience working for a health insurance provider. Utilization Management experience is a plus.

Required Skills/Experience – The rest of the required skills/experience.  Include:

• Strong writing and communication skills - The ability to write clear, concise, and accurate policies and procedures is essential. The writer should be able to communicate complex medical concepts in a straightforward and accessible way.
• Research and analytical skills: The ability to conduct research, analyze data, and draw conclusions to inform policy development is essential. The writer should be able to stay up-to-date with industry trends, best practices, and emerging issues.
• Attention to detail and organizational skills: Medical policy writers must be meticulous and organized, with the ability to manage multiple projects and deadlines. They should be able to prioritize tasks, maintain accurate records, and ensure version control.

Preferred Skills/Experience – Optional but preferred skills/experience.  Include: 

• Technical Skills: Proficiency in Microsoft Office, particularly Word, and experience with content management systems, document management software, or other relevant tools are necessary.
• Collaboration and stakeholder management: The writer should be able to work effectively with various stakeholders, including healthcare professionals, administrators, and other subject matter experts, to gather input and feedback on policies.
• Prepare and format documents according to industry standards, journal guidelines, and client specifications, including manuscript formatting, reference formatting, and document styling, to facilitate submission and publication.
• Review and revise draft documents for content accuracy, clarity, coherence, and consistency, incorporating feedback from subject matter experts, project stakeholders, and regulatory reviewers to ensure document quality and compliance with requirements.

Education/Certifications – Include: 

• Bachelor’s degree in nursing minimum, prefer Master’s in Nursing or related field
• Current RN Licensure

Ready to make an impact? 🚀 Apply now and let’s grow together!

Job Tags

Permanent employment, Contract work,

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