Medical Policy Analyst Rn

Horizon Blue Cross Blue Shield of New Jersey

Remote
$79,100 - $105,945; not specified; comprehensive h...
Medical policy determination
Claims analysis
Research medical techniques
This position is responsible for the medical policy determination of claims/cases consistent with Plan Medical Policy to ensure appropriate and efficient utilization of benefits

Job Summary

  • This position is responsible for the medical policy determination of claims/cases consistent with Plan Medical Policy to ensure appropriate and efficient utilization of benefits.
  • The position is responsible for the research and analysis of medical techniques, procedures and products and for recommendations in the formulation of draft medical policy.
  • At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.

Matching Summary

This position is responsible for the medical policy determination of claims/cases consistent with Plan Medical Policy to ensure appropriate and efficient utilization of benefits.

Salary

$79,100 - $105,945; Not specified; Comprehensive health benefits

Skills & Requirements

Must-have

  • Medical policy determination
  • Claims analysis
  • Research medical techniques
  • Formulate medical policy
  • Manage assigned inventory
  • Stay abreast of mandates

Nice-to-have

  • Client service focused
  • Empathy
  • Professional and ethical business practices
  • Commitment to growth

Key Requirements

  • Active Unrestricted RN License Required
  • Minimum 2 years clinical experience
  • 3 years healthcare delivery system experience
  • High School Diploma/GED required
  • Bachelor degree preferred or relevant experience

Work Rights

Not specified

Tailored Resume

Cover Letter