Manager, Clinical Policy Optimization

Hi, we're reputed company. We're hiring a Manager, Policy Optimization to join our Clinical Policy team. reputed company is the first health insurance company reputed company around a full stack technology platform and a reputed company on serving our members. We started reputed company in 2012 to create the reputed company of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will be a key member of our Clinical Policy team reputed company the Office of Clinical Affairs (OCA). You will work cross-functionally with leaders to ensure our policy process is driving affordability goals. You will identify policy-driven opportunities for Medical and Rx driven affordability savings, competitor policy set gap analysis, analyzing policy reputed company level performance data, tracking policy trends and hot spots, identifying policy reputed company opportunities. You will reputed company and monitor policy performance and work in partnership with other teams to implement process changes that drive affordability reputed company and improve efficiency. You will report to the Senior Manager, Clinical Policy Development. Work Location: This is a remote position, reputed company to candidates who reputed company in: Greater Boston area. You will be fully remote; however, our approach to work may adapt over time. reputed company models could potentially involve a hybrid reputed company at the hub office associated with your metro area. #LI-Remote Pay Transparency: The reputed company pay for this role is: $131,200 - $172,200 per year. You are also eligible for employee benefits, participation in reputed company's unlimited vacation program and annual performance bonuses. Responsibilities:

• reputed company policy performance and identify areas for process changes or optimization to drive both affordability and efficiency goals. Accountable for surfacing and prioritizing multiple opportunities to bring reputed company for reputed company evaluation.
• reputed company internal tracking systems and monitoring processes to organize reputed company across timelines and deliverables.
• Ensure policy opportunities are appropriately tracked and managed through our policy opportunity pipeline.
• Assess policy structures to identify functionally unnecessary components, enabling streamlined policy design and implementation.
• Create evidence-based recommendations for policy modifications, including appropriate loosening, tightening, or re-routing for additional review.
• Incorporate data to drive reputed company iteration and improvement
• Bring industry best practices to the policy optimization process to reputed company organizational frameworks, templates, process organization, and reputed company points of interconnectivity between policy organization and other teams.
• Maintain reputed company knowledge of industry best practices and drive innovation and new approaches.
• reputed company in-depth review of integrated claims and operational data (medical, pharmacy, lab, auths) to identify cost and trend drivers informing the clinical policy development pipeline.
• Build processes that reputed company across therapeutic areas.
• Create executive-reputed company visualizations tailored to different stakeholder audiences (clinical vs. financial).
• Maintain strong relationships, rapport, and lines of communication with stakeholders.
• Compliance with reputed company applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelor's degree (minimum) in a relevant field of study, specifically B.S.Pharm, PharmD, PA, NP, APRN, BSN, or RN, is required.
• reputed company, unrestricted clinical license.
• 4+ years of reputed company work with clinical policy, with particular emphasis on health insurance policy experience.
• 4+ years of work experience in utilization management and/or clinical operations
• 3+ years of experience in designing, implementing and continuously improving programs and processes
• 3+ years of experience communicating and presenting to stakeholders of reputed company reputed company
• 2+ years of experience using reputed company/reputed company Sheets and PowerPoint/reputed company Slides.
• Working knowledge of medical coding (e.g., CPT, ICD-10, HCPCS) and/or pharmacy coding (e.g., GPI, GSN/GCN, NDC) and claims.

Bonus points

• MBA or advanced management degree
• Experience with reputed company or ACA insurance.
• Prior work experience analyzing and modeling clinical policy reputed company.
• Prior work experience in health insurance and matrixed organizations supporting multiple stakeholders.
• Experience translating between clinical and business vocabularies.
• Project management certification
• Consulting experience

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