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Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:
Research and develop medical coverage policies (Commercial and Medicare) utilizing a standardized checklist and an evidence based medicine review process as well as CMS coverage guidelines
Provide comprehensive verbal and written summation of research to medical directors and leadership during pre-Technology Assessment Forum (TAF) meetings and to the TAF committee as well as for Medicare UMC meetings
Perform ad hoc medical research for medical directors as needed for individual case reviews
Perform research regarding new CPT and HCPCS codes as required on a quarterly basis
Interdepartmental committee participation
Liaisons with external entities such as medical device manufacturers and medical professional societies
Please note this role will consist of working mostly independently to review at times large amount of clinical information to update clinical policies. The ideal candidate for this role would ideally enjoy researching, reading and writing policies independently. Success in this role requires:
Required Qualifications
Bachelor’s degree in any healthcare related field.
5 years or more of prior clinical experience.
Proficiency with Microsoft Office products including Word and Excel
Preferred Qualifications
Bachelor of Science in Nursing (BSN) - Active, unrestricted Registered Nurse (RN) license required.
Master’s degree in health-or business-related field
Utilization management experience (Commercial and/or Medicare)
Proven successful experience in compiling health-related research, with associated analysis and conclusions.
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of these employees must meet the following criteria:
Additional Information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours
40Pay 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.$84,600 - $116,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Full Time
Insurance
$108k-139k (estimate)
05/11/2024
05/17/2024
humana.com
TEMPE, AZ
15,000 - 50,000
1961
ALISON RITCHHART
>$50B
Insurance
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on puttin...g the customer first.
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