Medical Policy Developer/Research Specialist II

The Fountain Group is currently seeking a --Medical Policy Developer/Research Specialist II for a prominent client of ours. This position is located in Phoenix, AZ. Details for the position are as follows:

Job Title: Medical Policy Analyst (Level I/II)

Location: Remote

Pay Rate: $37.93/hr

Duration: 6 Months

Job Description

Perform medical technology research to support coverage guidelines and medical policy decisions. Evaluate and summarize clinical evidence for new and emerging technologies. Develop, revise, and maintain medical coverage guidelines and criteria aligned with industry standards. Conduct code review activities and support integration into benefit programming. Facilitate external consultant reviews for policy evaluation and summarize findings. Contribute to medical policy panels and clinical coding governance initiatives. Ensure compliance with regulatory, accreditation, and organizational policy requirements.

Education

• AZ license or compact license that covers AZ
• AA degree in nursing at a min - BS degree preferred
• LPN cert at a min - RN preferred
  
  

Required Skills

• Medical policy development and coverage guideline evaluation
• Medical technology assessment and clinical evidence analysis
• Clinical coding review and healthcare coding standards
• Utilization management guidelines (MCG, InterQual, eviCore)
• Regulatory and accreditation compliance (State/Federal healthcare standards)
• Clinical research and literature review methodologies
• Healthcare policy documentation and protocol development
  
  

What to look for:

• Person will research Medical director staff and technology standards
• This person will research and provide updates to the committee
• Will be creating policy that they use for the utilization management. Ie: criteria that are not covered from the state or federal government
• Role is research and writing and a background in UM because thats what you will be
• Background as a Nurse that has worked with a healthplan and has been a reviewer or done UM ideally for inpatient or prior authorization
• Preference to RN - but will consider LPN if they have strong UM background
• Must be comfortable writing
  
  

What to look for:

• AA degree in nursing at a min - BS degree preferred
• LPN cert at a min - RN preferred
• Prior experience with Utilization management
• Expeirence as a nurse that has worked with a healthplan and has reviewed utilization management for inpatient or prior authorization
• Strong writing skills
• Any expeirence creating policies relating to utilization management
  
  

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