Description
Description
The Medical Policy Manager is responsible for the management and supervision of all medical policy development, quality, implementation, publication, and routine updates. The Policy Manager will coordinate, manage, and direct all aspects of the Plan's policy life cycle and will ensure all coding, regulatory, legal, operational, and evidence-based best practices are maintained, consistent and documented across all Policy Teams. Critical to the success of this role is demonstration of mange care savings targets of +$7 million annually directly related to implementation of new policies with positive ROI. This role will direct reports that will include Master's and PhD-level Medical Policy Analysts, Policy Coordinators, and other caregivers, as required. The Medical Policy Manager is responsible for building and maintaining strategic internal and external relationships as they relate to administration and operationalization of medical policies for all lines of business, clients, and business partners.
Providence caregivers are not simply valued they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
- Bachelor's Degree in Nursing or other clinical or healthcare related field.
- Master's Degree in Healthcare Administration, Public Health.
- 5 years related experience in healthcare policy research and development, preferable in a payer setting.
- 5 years leadership experience.
- 3 years demonstrable experience in program management and project management.
- 3 years experience with assessing and evaluating data analytics.
Preferred Qualifications:
- 3 years experience with CMS, Medicaid, and state(s) regulatory requirements and quality accreditation bodies (e.g., NCQA).
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act."
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requsition ID: 387553
