To be fully engaged in providing No Harm / Quality, Customer Experience, and Stewardship by developing and maintaining Medical Policies that define medical necessity under Health First benefit plans. The position creates value by maximizing operational effectiveness in the Utilization Management area, ensuring consistent and appropriate decision-making and minimizing legal risk. Medical Policy Administration involves the analysis of health data, clinical research, cost-effectiveness, and health policy, with the development of professional written Policies and other communication tools. Generally works under specific deadlines and frequently handles multiple complex projects, operating with minimal supervision.
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Qualifications:
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