Senior Clinical Policy Research Professional

Job Summary

Employment Type: Full time

Become a part of our caring community and help us put health first. The Senior Market/Industry Insights Professional works closely with Humana's medical directors to research, develop, and maintain medical coverage policies utilizing an evidence-based medicine review process.

Location: Work at home anywhere

Role Responsibilities

Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:

• Research and develop medical coverage policies utilizing a standardized checklist and an evidence-based medicine review process
• Provide comprehensive verbal and written summation of research to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA)
• 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 amounts of clinical information to update clinical policies. The ideal candidate for this role would ideally enjoy researching, reading, and writing policies independently.

Use your skills to make an impact.

Required Qualifications

• Bachelor of Science in Nursing (BSN) or Bachelor’s degree in any field or equivalent experience
• Active unrestricted Registered Nurse (RN) license
• 5 years or more of prior clinical experience
• Strategic thinking and planning capabilities; organized and detail-oriented
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Proficiency with Microsoft Office products including Word and Excel
• Self-directed with demonstrated ability to meet strict deadlines
• Strong analytical and web navigation skills

Desired Qualifications

• 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

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support, and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; 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.

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.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number.