[Hiring] Policy Development Analyst - Senior @Intermountain Health

Role Description

Leads the development and implementation of health plans policies, which are used to develop adjudication rules, define coverage for benefits, program the claims payment system and develop provider reimbursement schedules. Leads the implementation process which affects or are affected by the policies. Bridges the gap between broad policy and product concepts and operational practice throughout Select Health.

• Leads the research process which includes initial request for policy development or modification through analysis and development of recommended policy to senior management, and implementation of approved policy.
• Develops policies considering the fit with organizational goals and strategies, impact on organization's initiatives, long-term marketing strategies, and the amount of clinical input required.
• Presents recommendations, answers questions about the analysis as well as impacts and ease of implementation.
• Oversees the implementation of approved policy/product changes and coordinates the efforts of an implementation team with affected management and their functional areas of responsibility.
• Provides support and acts as a resource for projects or teams needing extensive input from a policy specialist.
• Stays current on changes, practices, policies, and all aspects of the business to provide accurate information about benefit quoting and proper adjudication.
• Oversees the coding review process, makes coverage and benefit determinations on each individual code.
• Champions and leads initiative for policies requiring change.
• Participates in functional area committees to ensure consistent policy development.
• Assists in other product development activities and projects, such as benefit design research, member satisfaction research and market research, as well as project tracking, prioritization, and other related project management activities.

Qualifications

• Four years of policy experience.
• Two years of experience in a medical benefits or insurance setting, or other related work experience.
• Experience managing projects that require strong interpersonal and organizational skills.
• Excellent oral, written, and interpersonal communication skills.
• Intermediate skills in computer-based word processing and spreadsheets.

Requirements

• Bachelor's Degree in a business or healthcare related field (preferred).
• Four years of project management experience in a regulatory or insurance setting (preferred).
• Demonstrated intermediate knowledge with claims adjudication systems (preferred).
• Strong organizational, data gathering, and data analysis skills (preferred).
• Excellent problem solving, negotiation, and process improvement skills (preferred).
• Experience with policy, research, operations or analytics within a pharmacy or PBM setting (preferred).
• Experience with medication-centric utilization management or formulary management platforms and applications (preferred).
• Familiarity with regulatory and industry standards (such as NCPDP) (preferred).

Benefits

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Company Description

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.