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PG
Regional Sales Manager
Potter Global Technologies
Roanoke, VA
- $90,000 to $200,000 USD / year
Join Us as a Regional Sales Manager - New Jersey/ Metro NY at Potter Global Technologies
Added just now
PG
Regional Sales Manager
Potter Global Technologies
Roanoke, VA
- $90,000 to $200,000 USD / year
Join Us as a Regional Sales Manager at Potter Global Technologies
Added just now
Customer Success Manager - Bolingbrook, IL
Formic
Bolingbrook, IL
As Customer Success Manager, you will serve as the primary point of contact and advisory partner for our customers: visiting and consulting with those customers in the field, and driving…
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Assistant Fire Control Inventory Manager
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…accuracy, coordinate material availability, and provide input to project and program plans to ensure products are properly supported throughout their lifecycle. As an Inventory Manager,…
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UI
Technical Project Manager
UBERETHER INC
Sterling, VA
- $150,000 to $160,000 USD / year
As a Project Manager at UberEther, your role includes leading discovery and analysis efforts to address and solve the challenges inherent in large-scale Identity and Access Management (IAM)…
Added 1 min ago
Lead Energy Engineer
ICF
Albuquerque, NM
ICF is growing its energy and distributed energy resource program implementation teams. We are seeking a Lead Energy Engineer to support non-residential transportation electrification,…
Added 2 mins ago
GTM Enablement Manager
Pave
San Francisco, CA
…in. This is a first-of-its-kind role: you will take a running program and turn it into a measurable…
Added 4 mins ago
Intern, Lab Engineering
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South Chesterfield, VA · Chester, VA · Chesterfield, VA
…have a responsibility to deliver on inspiring projects. Your manager will offer coaching, mentoring, and direction. You will be assigned to a technical project in one of the following…
Added 4 mins ago
Program Manager
Wabash
Lafayette, IN
The Program Manager, Digital Enablement is accountable for leading enterprise application programs and strengthening portfolio and project delivery across Digital Enablement. This role…
Added 4 mins ago
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Budget Manager - Fiscal Operations
State of Louisiana
Baton Rouge, LA
- $30.43 to $56.86 USD / hour
Job Focus AreaThe Budget Manager serves as a strategic financial leader within the Louisiana Department of Education (LDOE), providing leadership, direction, and oversight for budget…
Added 5 mins ago
Engineer I
New Jersey Resources
Wall, NJ
…distribution, transmission, and regulator station facilities. Oversee project scope, schedules, budgets, and subcontractors from concept through completion. Ensure all design and…
Added 6 mins ago
Software Engineering Manager - Asset Management Group Technology
PNC
Pittsburgh, PA · Farmers Branch, TX · Lakewood, CO · Strongsville, OH · Phoenix, AZ
As a Software Engineering Manager within PNC's Asset Management Group (AMG), you will lead and develop a team of software engineers responsible for delivering scalable technology solutions…
Added 6 mins ago
Electrical Engineer
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…compliance and restoration, audit assertions, acquisition, and program management. The unit conducts its operations at more than 75 locations worldwide. CNSP is seeking a Senior…
Added 8 mins ago
Senior Manager, Customer Success (Remote, US)
Everyday Electric
Remote, United States
As a Senior Manager, Customer Success, you will own the strategic direction, health, and partner engagement for a portfolio of our highest-complexity, highest-value Utility VPP partners.…
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United States
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Highway Maintenance Engineer
State of Indiana
Crawfordsville, IN
- $85,020 USD / year
…coordinating, reviewing, and making recommendations for the Technical Services Section and acts as a liaison between the District and subdistricts in coordinating, reviewing and making…
Added 9 mins ago
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Program Controls Manager
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San Diego, CA
- $190,000 to $215,000 USD / year
Kitchell is seeking an experienced and dedicated Program Controls Manager to join our Southern California region in San Diego and build a long-term career at one of the most innovative and…
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Project Manager - 100% Travel Required
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Job Summary: The Low Voltage Project Manager is the overall manager for assigned project(s). The Project Manager ensures that all contracted work is developed, implemented, installed and…
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Works with the Project Engineer and Program Manager to define project objectives, prepare design estimates, and define project requirements and design approaches for large or complex…
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…outside consultants, carriers, and vendors, serve as the top technical escalation point, and bring major decisions to the Director of IT with a clear…
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Project Manager - Fire/Life Safety Systems - Albuquerque, NM
Military Spouse Jobs & VetJobs
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Added 11 mins ago
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Obtain client signatures upon commissioning completion and submit documentation to the Project Manager.
Added 11 mins ago
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STERIS Corporation
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Obtain client signatures upon commissioning completion and submit documentation to the Project Manager.
Added 13 mins ago
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TWDB 27-14 Engineer I-III/Project Manager IIS-IIIS
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- $6,126 to $7,577.51 USD / month
…and implementation of all State funded programs, oversight, technical review and evaluation of reports, and other project and program documents. Ensure the new programs and opportunities…
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Sr. Quality Specialist, QMS & Compliance
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…a pharmaceutical CDMO environment. Reporting to the Senior Manager, Quality Systems & Compliance, the role plans, coordinates, conducts and documents internal audits, customer audits,…

Wayspring

Policy Manager

Nashville, TN, United States

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Job details

Posting language: English

Original job description

Policy Manager Overview

The Policy Manager plays a key role in Wayspring’s work to improve the quality, affordability, and effectiveness of care for individuals with complex behavioral health needs. As a core builder and author of Wayspring’s behavioral health policy library, this person turns evidence into policies that become claims edits, chart-review rubrics, and policy content delivered to health plans.

This role is responsible for researching, developing, evaluating, and maintaining behavioral health clinical and payment policies. The Policy Manager will use clinical evidence, healthcare research, regulatory guidance, ASAM criteria, claims and utilization data, coding standards, and industry best practices to develop thoughtful, evidence-based policies that support appropriate care, medical necessity, payment integrity, and responsible utilization of healthcare services. Each policy is written to be precise enough to codify, so it can be applied consistently across utilization management, claims edits, and chart review.

This position will work cross-functionally with the Associate Medical Director, clinical leadership, Clinical Auditors, Network Solutions, Analytics, Compliance, Operations, engineering, and health plan partners. The ideal candidate is a strong researcher and critical thinker who enjoys becoming a subject matter expert in complex healthcare topics and can translate research and evidence into clear, practical, and defensible policies. This is a build-stage role: you will help shape how Wayspring writes, approves, and codifies policy, and how quickly the library grows.

Why Wayspring? We are passionate about breaking barriers alongside those with complex behavioral health needs. Whether you’re in the field or in the corporate office – our mission is felt, and your impact is recognized. There is no inner circle, and we all have a seat at the table. Leaders are accessible and silos are avoided. We respect your craft and love to be challenged. We invest not only in our mission, but in each other. Internal promotions and cross departmental training are the norm – you grow, we grow.

Responsibilities of the Policy Manager

Policy Research & Development

Research, develop, review, and maintain clinical and payment policies related to behavioral health services
Conduct in-depth research of clinical literature, regulatory guidance, reimbursement requirements, coding standards, and industry best practices to support the development of evidence-based policies
Research and interpret applicable CMS and Medicare, state Medicaid, ASAM criteria, CPT, HCPCS, ICD-10-CM, and health plan requirements, applicable national practice guidelines, [MF1.1]accounting for differences in Medicaid requirements, behavioral health regulations, and reimbursement practices across states
Monitor emerging behavioral health treatment practices, regulatory developments, and industry trends, and work with the Associate Medical Director on policy ideation to identify new policies or updates to existing policies
Analyze claims, utilization, provider, clinical, and other healthcare data, along with Network Solutions findings, to identify trends and opportunities that may warrant further research or policy development
Evaluate health plan policies, claims rules, utilization management requirements, and reimbursement methodologies to identify opportunities for greater accuracy, consistency, and effectiveness
Develop supporting research and recommendations that clearly articulate the evidence and rationale behind proposed policies

Policy Library & Content Management

Translate complex clinical, regulatory, research, and reimbursement concepts into clear, actionable policies authored in a structured, codifiable format within Wayspring’s content management system
Maintain version control, source citations, and organized documentation of research, supporting evidence, policy decisions, stakeholder feedback, revisions, and approvals.
Keep the library current by reviewing published policies as clinical evidence, regulations, coding standards, and health plan requirements
Meet policy creation throughput goals while managing multiple research and policy initiatives simultaneously
Help expand the library into new behavioral health subsectors as Wayspring’s offering grows

Policy Approval & Implementation

Move policies through the clinical review and approval workflow in partnership with the Associate Medical Director and clinical leadership, ensuring each reflects clinical evidence, medical necessity principles, and the needs of complex behavioral health populations.
Partner with coding and engineering teams to translate approved policies into claims-edit logic and rules
Help draft and inform chart-review rubrics with clinical leadership so that pre-pay and post-pay reviews apply policy consistently
Use findings from Clinical Auditors’ chart reviews to refine policies, rubrics, and claims-edit logic
Support behavioral health payment integrity initiatives across the claim lifecycle, including prior authorization and utilization management, claims edits, pre-pay and post-pay chart review, and recovery
Support implementation and ongoing evaluation of approved policies, including identifying unintended impacts, provider considerations, operational challenges, and opportunities for refinement

Cross-Functional & Health Plan Partnership

Partner with Network Solutions, Clinical, Compliance, Operations, and other teams to assess the potential clinical, operational, and financial implications of proposed policy changes
Prepare policy documents and supporting materials for review with clinical leadership, internal stakeholders, and health plan partners
Test initial policies against health plan expectations, participate in health plan and internal policy discussions, and communicate complex research and policy recommendations in a clear, concise manner
Contribute knowledge and research expertise to the continued development of Wayspring’s behavioral health solutions
Complete additional projects and responsibilities as assigned

Required and Preferred Qualifications

Required

3+ years of relevant experience in healthcare research, health policy, behavioral health, clinical policy, payment integrity, utilization management, healthcare analytics, medical coding, claims, reimbursement, or related areas
Demonstrated experience working extensively with generative AI and AI-enabled tools, with familiarity building and refining AI-supported research and content workflows. Must be highly comfortable using AI to synthesize complex information, develop and iterate content, and improve efficiency while maintaining strong standards for accuracy, source validation, privacy, and human oversight
Demonstrated ability to conduct research on complex healthcare topics and synthesize findings into clear, actionable recommendations
Experience evaluating clinical literature, regulatory guidance, healthcare data, industry standards, or similar evidence sources
Strong analytical and critical-thinking skills, with an ability to evaluate multiple sources of information and develop well-supported conclusions
Excellent written communication skills with the ability to translate complex research and technical information into clear, precise, understandable policy
Strong verbal and interpersonal communication skills with the ability to present research findings and policy recommendations to clinical, technical, operational, and client-facing audiences
Strong organizational and project management skills with the ability to prioritize multiple initiatives and meet deadlines
High level of curiosity and willingness to develop deep subject matter expertise in complex and evolving areas of behavioral health
Ability to work both independently and collaboratively in a fast-paced, cross-functional environment

Preferred

Master’s degree in public health, health policy, healthcare administration, behavioral health, psychology, social sciences, research, or related discipline
A strong academic or professional research background, particularly experience conducting literature reviews, evaluating clinical evidence, interpreting healthcare policy or regulatory guidance, and translating complex research into actionable recommendations.
Experience with behavioral health, substance use disorder, serious mental illness, Medicaid, managed care, or other complex healthcare populations
Knowledge of healthcare reimbursement, medical necessity, utilization management, claims, payment policy, or health plan operations
Familiarity with CMS, Medicaid, CPT, HCPCS, ICD-10-CM, and other applicable healthcare standards
Familiarity with ASAM criteria and level-of-care determinations for substance use disorder treatment
Experience writing medical or payment policy at a health plan or a policy or payment integrity vendor
Experience writing structured content for software or rules engines or working closely with engineering teams to translate requirements into logic
Experience working within a health plan, managed care organization, value-based care organization, healthcare research organization, provider organization, consulting environment, or similar healthcare setting
Experience in a startup or build-stage environment where processes are still being defined[MJ2.1]

Our goal is to foster a workplace where everyone feels a true sense of belonging, is supported, and empowered to thrive. We actively seek different backgrounds, perspectives, and experiences - because we believe that drives better performance and innovation. We’re committed to identifying and removing barriers for the communities we serve.

Benefit Summary

Creating a great employee experience takes more than just perks - but let’s be real, those matter too. Here’s how we’re building a company where you, your family, your pets, and your passions can thrive.

Comprehensive Medical, Dental and Vision Insurance options – including options for your pets!
Company funded HSA + Monthly Gym Allowance
Paid parental leave – all parents included!
Company paid short term disability, long term disability and life insurance
401k with company match
Premium Employee Assistance Program, inclusive of counseling sessions
Pardon and Expungement Scholarship Program
Company Contributions to Future Minded Savings (HSA and Emergency savings fund)
Generous PTO package (accrual policy based on years of service) and an additional 10 paid company holidays
Company 2 week paid sabbatical program!
Provider Benefits include ASAM training and membership + $2,500 CEU annual stipend and more!

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More about this job

Skills

Research
Leadership
Regulatory compliance
CMS
CPT
HCPCS
Policy development
Documentation
Workflow
Medical coding
Critical thinking
Communication skills
Project management
Meet deadlines
Social sciences

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