Medical Policy Specialist Ii

Horizon Blue Cross Blue Shield of New Jersey

New Jersey, US
$97,800 - $133,455; not specified; comprehensive h...
Medical literature research
Cms directives incorporation
Data analysis for business impact
This position is responsible for the development and maintenance of Horizon Blue Cross and Blue Shield of New Jersey (HBCBSNJ) medical policy in conjunction with physician staff and the coordination of policy implementation

Job Summary

  • This position is responsible for the development and maintenance of Horizon Blue Cross and Blue Shield of New Jersey (HBCBSNJ) medical policy in conjunction with physician staff and the coordination of policy implementation.
  • The role involves researching medical literature, monitoring government directives, and analyzing financial and data impacts of new policies.
  • Horizon offers a comprehensive compensation and benefits package including health benefits, retirement plans, generous PTO, and tuition reimbursement.

Matching Summary

This position is responsible for the development and maintenance of Horizon Blue Cross and Blue Shield of New Jersey (HBCBSNJ) medical policy in conjunction with physician staff and the coordination of policy implementation.

Salary

$97,800 - $133,455; Not specified; Comprehensive health benefits, Retirement Plans, Generous PTO, Incentive Plans, Wellness Programs, Paid Volunteer Time Off, Tuition Reimbursement

Skills & Requirements

Must-have

  • medical literature research
  • CMS directives incorporation
  • data analysis for business impact
  • medical policy database maintenance
  • provider portal accuracy
  • vendor program change control

Nice-to-have

  • innovative and inclusive environment
  • mission-driven organization
  • collaboration and growth focus

Key Requirements

  • High School Diploma/GED
  • 5-7 years clinical nursing/physician experience
  • 3-5 years medical claims processing experience
  • Clinical research and policy development experience
  • Data management experience
  • Active Unrestricted NJ RN License or foreign-trained physician preferred

Work Rights

Not specified

Tailored Resume

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