What are the responsibilities and job description for the Medical Policy Clinical Specialist position at Johns Hopkins Health Plans?
Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. YOU belong here.
What you’ll do:
The Medical Policy Clinical Specialist reports to the Manager of Medical Policy and conducts clinical, regulatory, and industry standard research for the development of JHHP medical policies. Under the direction of the Manager and Medical Policy Medical Director, drafts policy based on research of evidence for procedure/treatment/device under consideration for policy development. Collaborates with the medical policy team and assists in monitoring the medical policy cycle timelines from policy creation to implementation. Work with subject matter experts to present drafted written policies for consideration by the Medical Director and Medical Policy Advisory Committee (MPAC). Collaborate with coding specialists to provide objective analysis of JHHC coverage and preauthorization requirements with medical policy revisions to ensure consistency of philosophy
What awaits you:
- Work-life balance - This is a remote role!
- Medical, Dental, and Vision Insurance.
- 403B Savings Plan w/employer contribution.
- Paid Time off & Paid holidays.
- Employee and Dependent Tuition assistance benefits.
- Health and wellness programs and MORE!
What you’ll bring:
- Bachelor's Degree in Nursing required. RN with equivalent work experience may be substituted as appropriate.
- Minimum of 5 years’ clinical nursing experience, including acute care required. Technical, policy, procedure writing research experience required; Experience with medical policy writing preferred. Healthcare payer and/or managed care experience is a plus.
- Active RN licensure in the state of Maryland.
Preferred Knowledge:
Knowledge of managed care and healthcare payer principals; Knowledge of policy writing, research and development; Knowledge of CPT, HCPCS, and ICD 10.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
Salary Range: Minimum 39.94 per hour - Maximum 61.91 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.
In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!
Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
