Medical Policy Manager jobs in Texas

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Medical Policy Consultant
  • Elevance Health
  • Denison, TX FULL_TIME
  • National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

    Location: This is a virtual position, and preferred candidates reside within 50 miles of an Elevance Health PulsePoint location.

    Shift: Monday - Friday 8 am - 4:30 pm EST.

    The Medical Policy Consultant is responsible for researching and drafting NGS Medical Policy ensuring the use of valid and consistent research methodologies.

    How You Will Make An Impact

    • Conducts structured research within defined methodologies.
    • Drafts and modifies policies using consistent template tools and criteria.
    • Review new and updated codes for accuracy and consistency.
    • Research relevant studies and review articles for the development of local coverage determinations, coverage articles, and coding guidelines and for responses to inquiries from providers.
    • Finalizes issues and ensures implementation of these policies.
    • Works with other internal areas and with the Medical Directors to respond to internal and external requests that seek written clarification of a general or specific policy question. The response may be a reiteration of an established policy a redefinition of the current policy or research to determine a new revised policy.
    • Attendance and understanding of edits via the Edit Effectiveness meetings is a critical skill.
    • Ability to think on your feet and learn the policy consultant job quickly.
    • Scheduling Open Meetings/CACs and informal meeting processes must be learned.
    • Review and respond to OIG, CMS questions, and FOIA requests in a timely fashion.
    • Must be able to formulate a written policy in collaboration with Medical Directors and attend workgroup meetings and weekly CMD/MPU meetings. This must be based on significant research using Hayes and other tools available to the policy team.

    Minimum Requirements

    • Requires a BA/BS degree in a related field and a minimum of 2 years related experience; or any combination of education and experience which would provide an equivalent background.
    • Travels to worksite and other locations as necessary.
    • Working knowledge of coding is required.
    • This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States at least three of the past five years.

    Preferred Skills, Capabilities, And Experiences

    • RN license is preferred.
    • Prior medical literature research experience or related experience is preferred.
    • Technical writing experience preferred.
    • Excellent writing and communication skills and attention to detail as well as a love of research.
    • In-depth knowledge of ICD-10, CPT, and HCPCS codes is preferred.
    • Understanding edits/audits in FISS and MCS is preferred.

    If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role-specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. The use of this job is limited to the Federal Government Services business unit.
  • Just Posted

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Manager, State & Local Policy
  • myGwork - LGBTQ+ Business Community
  • Arlington, TX FULL_TIME
  • This inclusive employer is a member of myGwork – the largest global platform for the LGBTQ business community. DescriptionWork hard, have fun, and make history with Amazon Public Policy. The Manager, ...
  • 4 Days Ago

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IT Policy and Compliance Manager
  • Group 1 Automotive, Inc.
  • Houston, TX FULL_TIME
  • Overview At Group 1 Automotive, we are seeking an IT Policy Manager to join our dynamic team. This role is crucial for developing, implementing, and maintaining our IT policies and standards to ensure...
  • 5 Days Ago

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Manager Coding Policy *Remote
  • Providence
  • , TX OTHER
  • DescriptionProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitmen...
  • Just Posted

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Manager - Accounting Policy & Standards
  • Fidelity Investments
  • Westlake, TX FULL_TIME
  • 2090704-3Job DescriptionThe Accounting Policy and Standards Manager is responsible for guiding the application of accounting rules by all Fidelity corporate legal entities. This position is a high-vis...
  • Just Posted

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Manager, EC-12 Policy
  • The Commit Partnership
  • Dallas, TX FULL_TIME
  • Job Summary:Commit Partnership is seeking a detail-oriented and strategic thinking advocate to join the Policy & State Coalitions Team to play a crucial role in advancing systemic change with an empha...
  • 11 Days Ago

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Head of Medical Writing
  • Barrington James
  • San Francisco, CA
  • Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
  • 6/12/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies, Inc.
  • Plainview, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/12/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Plainview, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/12/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Deerfield Beach, FL
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Noblesville, IN
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Head of Medical Writing
  • Barrington James
  • Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy
  • ExecuSearch
  • Atlanta, GA
  • The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy Rheumatology
  • UCB
  • Atlanta, GA
  • Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
  • 6/8/2024 12:00:00 AM

Texas (/ˈtɛksəs/, locally /ˈtɛksɪz/; Spanish: Texas or Tejas Spanish pronunciation: [ˈtexas] (listen)) is the second largest state in the United States by both area and population. Geographically located in the South Central region of the country, Texas shares borders with the U.S. states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexican states of Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the southwest, while the Gulf of Mexico is to the southeast. Houston is the most populous city in Texas and the fourth largest in the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$128,694 to $157,109

Medical Policy Manager in Miami, FL
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