Archived listing. The details below describe a past opening.
Fully Remote
SelectHealth - Murray
Full time
R186581
Job 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.
Essential Functions
- 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. Considers the fit with organizational goals and strategies, impact on organization's initiatives, long-term marketing strategies, and the amount of clinical input required to determine if the request fits the scope policy process.
- Presents recommendations, answers questions about the analysis as well as impacts and ease of implementation. Presents issues and recommendations based on findings.
- 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. Learns about policies and procedures associated with each functional area.
- Oversees the coding review process, makes coverage and benefit determinations on each individual code. Implements coding determination changes through documentation, system set up and, if necessary, provider communication.
- 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.
Minimum Qualifications
- Four years of policy experience.
- Two years of experience in a medical benefits or insurance setting, or other related work experience to gain a good understanding of claims and eligibility issues, basic medical coding expertise, and insurance product knowledge.
- Experience managing projects that require strong interpersonal and organizational skills and the ability to perform under stress and to meet deadlines.
- Excellent oral, written, and interpersonal communication skills.
- Intermediate skills in computer-based word processing and spreadsheets
Preferred
- Bachelor's Degree in a business or healthcare related field.
- Four years of project management experience in a regulatory or insurance setting.
- Demonstrated intermediate knowledge with claims adjudication systems.
- Strong organizational, data gathering, and data analysis skills.
- Excellent problem solving, negotiation, and process improvement skills.
- Experience with policy, research, operations or analytics within a pharmacy or PBM setting
- Experience with medication-centric utilization management or formulary management platforms and applications (including knowledge of pharmacy benefit configuration and/or claims adjudication)
- Familiarity with regulatory and industry standards (such as NCPDP) and demonstrated understanding of formulary and benefit design, prior authorization, step therapy, quantity limit, and other drug utilization rules
Skills
- Health Care Regulation
- Communication
- Project Management
- Decision Making
- Attention to Detail
- Analytical Thinking
- People Management
- Cultivates Necessary Relationships
- Initiative
- Accountability
Physical Requirements
- Ongoing need for employee to see and read information, documents, monitors, and be able to assess internal customer needs.
- Frequent interactions with colleagues, that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
- Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
- Expected to stand or sit in a stationary position at a desk for an extended period of time.
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$31.01 - $48.84
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.
Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .
By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.
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.
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All positions subject to close without notice.
Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.
Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.
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Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match.
Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)
The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.
All positions subject to close without notice.
Thanks for your interest in continuing your career with our team!