Providence Health & Services Medical Policy Research Analyst in Beaverton, Oregon
Providence is calling a Medical Policy Research Analyst to Providence Health Plan in Beaverton, OR.
In this position, you will:
Be responsible for the identification, appraisal, and summary of scientific literature, clinical practice guidelines, and state and federal health policy for the development and implementation of Providence Health Plan (PHP) and Providence Health Assurance (PHA) medical policies which serve as the basis of coverage decisions by internal clinical staff and external providers.
Have primary responsibilities which include critical evaluation of the current peer-reviewed scientific evidence to assess the relative safety and efficacy of medical devices, procedures, services and laboratory testing.
Synthesize findings from evidence assessments, clinical practice guidelines, medical director feedback, contracts, benefits and plan summaries to draft and review medical policy criteria to ensure all medical policies are evidence-based, administrable, and meet all regulatory, accreditation and contractual requirements for all departments and lines of business at Providence Health Plans.
Provide policy recommendations based on concise assessment summaries which highlight findings for consideration and approval at Medical Policy Committee and New Technology Assessment Committee meetings.
Work closely with Coding Compliance, Systems Administration, Service Operations and Product & Marketing to ensure proper coding edits are applied to all medical policies.
Engage with medical directors, reimbursement specialists and other key stakeholders to vet policy issues and provide in-service trainings as needed.
Be responsible for data analysis to support policy recommendations.
Required qualifications for this position include:
Master’s degree in a health science related field (e.g. nursing, pharmacy, public health, epidemiology, biostatistics, genetics) -OR-
Current licensure or professional certification (e.g., Registered Nurse or Physician's Assistant)
3 years of clinical or research experience
2 years of experience developing and drafting medical policies and assessing medical technologies
Preferred qualifications for this position include:
Health plan experience
Medical coding experience
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Health Plans
Req ID: 185311