Sr Medical Policy Res Cnslt

Researches and makes coverage recommendations concerning new technologies or pharmaceutical agents and new uses for established medical technologies. Manages short-term or long-term, high level projects.

Job Description:

Job Responsibilities

• Focusing on several phases of the medical policy development process and high level projects. Trains staff in the use of Medical Policy Manual, and orients other departments to the guideline process.
• Providing day-to-day guidance, support, and medical leadership for utilization reviews and quality improvement initiatives. Works directly with clinical leadership on initiatives and complex issues that involve documents developed and maintained by the department.
• Conducting analysis of medical policies, medical review appeals and the utilization of management functions.
• Performing comprehensive research and evaluation of medical issues technologies; leading in developing consistent reporting benchmarks.

Job Qualifications

Experience

• 3 years - Experience in the research and development of medical policies and guidelines
• 5 years - Clinical nursing experience required
• 1 year - Project management experience with demonstrated skills and successes

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Job Specific Requirements: 

Oncology nursing experience is a plus.

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Worker Sub-Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.