Medical Policy Research Consultant Senior Job:
Blue Cross and Blue Shield of Minnesota

20201-en_US
Blue Cross and Blue Shield of Minnesota
Eagan Minnesota
Healthcare
Description

About Blue Cross



At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people’s lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state’s first health plan, we’ve been serving the health care needs of Minnesotans for more than 80 years.



 



Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued — a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares.



 


Description Summary

As a member of the Medical Policy Team, the Medical Policy Research Consultant Senior is responsible for participating in development of medical policy strategy and development. This position is responsible for researching and analyzing the medical literature, clinical practice guidelines, and federal and state coverage decisions with the intent of developing medical policies for BCBSM and our national business, and researching new technologies and reviewing existing technologies for presentation to internal technology assessment groups, BCBSM committees and external stakeholders when applicable.

Accountabilities


  1. Develops medical policies for BCBSMN, and assure that changes in medical policies and supporting rationale are communicated to all lines of business, including Medicare, internal stakeholders and others as needed.

  2. Presents medical policy recommendations and supporting rationale to BCBSMN’s Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key groups.

  3. Participates as a team member in internal BCBSMN technology assessment committees.

  4. Serve as internal consultant to Medical Directors and staff on emerging medical technology issues.

  5. Serves as external consultant to providers, vendors, manufacturers, government agencies and other organizations on the technology evaluation and medical policy processes.

  6. Participates in BCBSMN efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation).

  7. As part of the Medical Policy Team, researches and analyzes scientific literature and medical policies around a clinical field to develop an organized, strategic approach taking into account the business integration into the policy development process. 

  8. Manage medical policy-related projects.


Requirements


  • Clinical bachelor’s degree working in health care environment (e.g. health care policy or clinical guidelines development) with 5 years experience working in a health care environment (e.g. health care policy or clinical guidelines development).

  • Knowledge of medical literature and technology assessment evaluation methods.

  • Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, and safety and appropriateness.

  • Knowledge of local and national health care environment and trends.

  • Ability to work independently, and deliver a product that is defensible before internal and external stakeholders.

  • Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms.

  • Excellent interpersonal skills. 

  • Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others.

  • Project Management experience.


Preferred Requirements


  • Master’s degree in a health related field with 5 years’ experience working in a health care environment (e.g. health care policy or clinical guidelines development)

  • Knowledge of CPT and ICD-9 coding helpful.


FLSA Status

Exempt

Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Basic Qualifications
Requirement