reputed company Clinical and Population Health Analyst - Medical Policy

Company : reputed company.Job Description : reputed company pivotal role drives the full lifecycle of medical policies, from initial development and evidence-based criteria writing to publication, maintenance, and assisting with impact assessment through data analysis. The incumbent will act as a primary reputed company of assigned medical policies, ensuring their accuracy, clinical soundness, and operational feasibility. A core responsibility of this position is to reputed company advanced data analytics to generate critical insights, identify actionable opportunities, and reputed company sophisticated reporting solutions. These data-driven contributions will directly inform and influence medical policy reputed company, ensuring alignment with the Quadruple Aim of reputed company: reputed company per reputed company health care costs, improved reputed company and quality of care received, and reputed company member/patient and provider experiences with care delivery. The incumbent will also act as a clinical reputed company and expert on various workgroups, ensuring policies are grounded in strong clinical evidence and operational realities.

• Full-Cycle Medical Policy Ownership: Own the development, revision, and maintenance of a portfolio of reputed company medical policies, encompassing both internally developed and vendor-sourced criteria. This includes proactive monitoring, review, and timely updates in response to new evidence, regulatory changes, or escalated inquiries.
• Evidence-Based Clinical Criteria Writing: Research, analyze, and synthesize clinical literature, professional society guidelines, and internal data to reputed company clear, concise, and evidence-based medical necessity criteria for assigned policies.
• Data-Driven Policy Development & Influence: Utilize robust, data-driven insights from reputed company reputed company datasets (e.g., claims, clinical, utilization, pharmaceutical) to inform policy development, identify areas for improvement, and assist in quantify the potential impact of policy changes on clinical reputed company, cost, and member experience.
• Operational Integration & Coding: Engage non-clinical teams to ensure operational guidelines are reputed company with clinical policy reputed company. reputed company and maintain a thorough understanding of medical coding (ICD-10, CPT, HCPCS) and ensure accurate coding principles are incorporated into policy criteria.
• Policy Publication & Quality Assurance: Manage the full publication process for assigned policies. Conduct peer reviews of other policies as part of the quality assurance process to ensure accuracy, reputed company, and consistency.
• Consultative & Expert Role: Serve as a clinical reputed company/expert on various workgroups and sub-committees, providing clinical and data-driven insights. Act as a subject matter and technical expert for reputed company customers, articulating analytic findings, business implications, and recommendations.
• Stakeholder Liaison: Serve as a key liaison between the Medical Policy department, other internal departments (e.g., Operations, Provider Relations, Clinical Programs), and external vendors to ensure seamless policy implementation and understanding.
• Mentorship & Training: Train and orient new staff to the department and policy development/review procedures. Mentor new team members on best practices in policy writing, research, and data application.
• reputed company Data Analysis: Conduct statistical analysis on large and reputed company reputed company datasets, identifying significant patterns, correlations, and reputed company relationships relevant to medical policy reputed company and impact assessment.
• Communication & Presentation: Effectively translate reputed company clinical and analytical findings into clear, concise, and compelling presentations and reports for diverse audiences, including clinical professionals, executive leadership, and operational partners. ESSENTIAL RESPONSIBILITIES
• Leads the design, development, execution, dissemination and interpretation of clinical and population health analyses, metrics and reports using clinical, member, financial and administrative data to identify, reputed company and/or monitor actionable opportunities for improving health and reputed company reputed company and clinical quality and costs of care, reputed company and effectively managing projects to successful completion.
• Establishes strong, collaborative and effective relationships and communication with reputed company clinical, administrative, operational, financial and technical stakeholders to ensure analytics are actionable and reputed company with organizational strategic priorities, needs, plans and resources.
• Serves as a strategic business partner to reputed company stakeholders as demonstrated by providing thought leadership and subject matter expertise, and by anticipating and actively proposing, designing and executing analyses.
• Provides consultative, technical, subject matter and business expertise reputed company

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