Clinical Policy Development Analyst (Remote) About the Opportunity A growing healthcare technology organization is seeking a Clinical Policy Development Analyst to support the development of evidence-based clinical policies that guide coverage and reimbursement decisions across a large payer network. This role will focus on researching emerging diagnostic testing and healthcare trends, evaluating clinical evidence, and developing clear, actionable policy recommendations. This is a highly collaborative position that partners with clinical, product, coding, operational, and technical teams to ensure policies are translated into practical implementation strategies.
Responsibilities
- Research emerging diagnostic tests, laboratory services, clinical technologies, and healthcare trends.
- Review and synthesize peer-reviewed literature, professional society guidelines, government coverage guidance, and other authoritative sources.
- Evaluate clinical evidence and identify opportunities for new or enhanced coverage policies.
- Draft, revise, and maintain clinical policies, including medical necessity criteria, coverage requirements, limitations, exclusions, and supporting references.
- Present policy recommendations to clinical reviewers and incorporate feedback throughout the approval process.
- Assess existing policies for accuracy, consistency, relevance, and opportunities for improvement.
- Maintain organized documentation, research summaries, policy histories, and supporting rationale.
- Collaborate with cross-functional stakeholders to ensure approved policies are implemented consistently and aligned with business objectives.
- Utilize approved AI-assisted research and evidence-review tools while validating all findings against authoritative sources.
- Manage multiple policy development projects in a fast-paced environment.
Qualifications
Required
- Experience evaluating clinical literature and translating evidence into clear, actionable policy language.
- Understanding of medical necessity criteria, healthcare coverage decisions, and payer policy development.
- Strong analytical, research, writing, and documentation skills.
- Ability to manage multiple projects and work effectively across cross-functional teams.
- Experience developing, drafting, or maintaining clinical, medical, or coverage-related policies.
Preferred
- Advanced clinical, scientific, or healthcare-related degree or professional credential (RN, PA, NP, PharmD, PhD, etc.).
- Experience within a health plan, managed care organization, utilization management organization, healthcare technology company, or related healthcare setting.
- Knowledge of diagnostic testing, laboratory medicine, pathology, or related healthcare services.
- Familiarity with commercial payer policies, Medicare coverage guidance, and healthcare coding concepts.
- Experience leveraging claims data, healthcare analytics, or AI-assisted research tools to support policy development.
What You'll Bring
- Strong critical thinking and evidence-evaluation skills.
- Ability to communicate complex clinical concepts in clear, concise written language.
- Experience balancing clinical evidence, operational considerations, and business value.
- Attention to detail and a commitment to producing high-quality work.
- A collaborative approach and the ability to influence stakeholders across multiple disciplines.
Location: Fully Remote (U.S.) Travel: Occasional travel for team meetings may be required. Compensation: Competitive base salary plus bonus opportunity. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions.