Become a part of our caring community and help us put health first
 

The Senior Clinical Policy Research Professional works closely with Humana's medical directors to research develop and maintain medical coverage policies utilizing an evidence-based medicine review process. This is a Remote opportunity.

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:

• Strong organization skills and detail-orientation
• Excellent verbal and written communication skills
• Strong analytical and web navigation skills
• Self-direction with demonstrated ability to meet strict deadlines.
• Strategic thinking and planning capabilities.

Use your skills to make an impact
 

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:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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

40

Pay 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 year

 

This 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 of