[Hiring] Senior Clinical Policy Research Professional @Humana

Role Description

The Senior Clinical Policy Research Professional works closely with Humana's dental directors and medical directors to research, develop and maintain dental and medical coverage policies utilizing an evidence-based medicine review process.

In this role you will:

• Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance.
• Provide comprehensive verbal and written summation of research to dental directors, medical directors and leadership during policy discussion meetings and to the MCCR MCPA committees.
• Perform ad hoc dental and medical research for dental directors and medical directors as needed for individual case reviews.
• Perform research regarding new CPT and HCPCS codes as needed on a quarterly basis and work closely with the PAL team to address PAL codes requiring clinical coverage policy guidance.
• Interdepartmental committee participation.
• Collaboration with stakeholders across the organization.

Please note this role will consist of working mostly independently to review large amounts of clinical information to update clinical policies.

The ideal candidate for this role would enjoy researching, reading and writing policies independently.

Success in this role requires:

• Strong organization skills and detail orientation.
• Excellent verbal and written communication skills.
• Strong analytical and web navigation skills.
• Self-direction with demonstrated ability to meet strict deadlines.
• Strategic thinking and planning capabilities.

Qualifications

• Associate or bachelor's degree in dental hygiene or dental assisting.
• Appropriate state certification or licensure as a dental assistant or dental hygienist.
• 5 years or more of prior clinical experience.
• Proficiency with Microsoft Office products including Word and Excel.

Requirements

• Master’s degree in health-or business-related field (Preferred).
• Utilization management experience (Medicare or Medicaid) (Preferred).
• Proven successful experience in compiling health-related research, with associated analysis and conclusions (Preferred).

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities.

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year.

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Application Deadline

06-04-2026