RN Medical Coverage Policy Consultant - Up to $74.20/hour

Job Description

Job Description

RN - Medical Coverage Policy Consultant - Full-Time/Part-Time

Pay Rate: Up  to $74.20/hour depending on experience!

Schedule: Open to Full-Time or Part-Time, expected to work dayshift business hours.

Location: This is a hybrid position,  candidates should be local to the Twin Cities Metro MN area or able to relocate!

*This is an open ended vacancy with the potential for it to become permanent. The position is expected to start within the next 2 months.

Position Summary: The Consultant is responsible for the development and implementation of medical policies which support clinical decision making coverage for services that are proven to positively impact healthcare outcomes. The position monitors medical literature for current and new technology and manages administrative criteria which supplement benefits and third-party resources. The Consultant collaborates with Claims, Utilization Management, Medical Directors, Contracts and Benefits, Member Services and Government Programs to support policy changes. One of the primary roles of the Consultant will be double checking new artificial intelligence technology's ability to interpret policies accurately and consistently.

Role Responsibilities:

• The primary role of the Consultant is to work with new artificial intelligence technology and identify the new technologies ability/tendencies when it comes to accurately/consistently interpreting policy details.
• Research and evaluate evidence based scientific literature and use critical thinking sills to summarize findings that effect medical coverage policies and benefits.
• Research and interpret benefit coverage across all health plan products including Commercial, Medicare, Medicaid and employer groups.
• Review and summarize informatics and claims reports to understand volume, costs and coding implications to support policy implementation.
• Develop/revise coverage criteria policies including administrative policies and benefit supplemented policies.
• Collaborates with other departments as needed and prepares implementation plans.
• Communicates coverage policy interpretation/rationale for coverage positions and implementation approach to providers, members, outside vendors, employer groups and internal departments.
• All other duties as assigned.

Requirements:

• Bachelor's Degree in nursing.
• RN licensed in MN with 3-5 years of medical policy experience/Utilization Review Management.
• 5 or more years of healthcare experience with expertise in the areas of scientific literature research and review, medical guideline development or coverage policy development.
• Experience with prior authorizations is preferred.
• Demonstrated health plan implementation experience/knowledge.  
• Experienced with Microsoft Word and Excel documents, multitasking skills, organized, effective communicator.
• Experience in medical coding (HCPCS, CPT, ICD-10) is preferred but not required.
• Expertise in Powerpoint and Visio, along with expertise in Medicare is preferred.

What We Offer:

• Locally owned and operated healthcare staffing agency

• Competitive pay

• Variety of clinic environments across the Twin Cities

• Free education courses

• PTO accrual based on hours worked

• Medical, Dental and Vision insurance for employees working 32+ hours / week

Company Overview:
Interim Healthcare is America's leading provider of home care, hospice, and healthcare staffing. We offer one of the most comprehensive selections of career opportunities in the industry ranging from per diem to full-time. If you're looking for a stable career opportunity, look no further. We offer the security of working for an established company. Nationally, Interim Healthcare has been providing great jobs to great people for over 50 years and there are more than 300 offices across the country. That kind of stability combined with our commitment to integrity makes us your perfect career partner. Interim Healthcare offices are independently owned and operated.