Medical Policy Specialist jobs in Oregon

Job Summary

The Policy Management Specialist is responsible for developing, implementing, and supporting CareOregon’s enterprise-wide Policy Management Program. Core areas of focus include assisting staff in writing quality and compliant polices, serving as administrator for PolicyTech software, monitoring to ensure policies are current, developing efficient processes, training staff on best practices, and tracking regulatory requirements.

Essential Responsibilities

• Develop, coordinate, and manage enterprise-wide policy management program including timeline, workflow, and resources that follow industry best practices.
• Develop a policy review schedule that aligns with contractual, corrective action, and federal and state requirements.
• Proactively engage staff to keep policy reviews timely, ensure policies are reviewed by all impacted teams/individuals, encourage collaboration, and mitigate duplication and inconsistency.
• Support staff in the creation and management of team/department specific annual policy review schedules.
• Receive and process requests to create new policies or make policy changes.
• Develop technical writing guidance, create required and on demand staff trainings, provide coaching, conduct quality reviews to ensure policy aligns with CareOregon’s Policy Management Policy, and develop an escalation process to enforce non-compliance.
• Develop and maintain status reports, including dashboards, for leadership.
• Engage, coordinate, and advise the Policy Oversight Committee to meet goals and objectives.
• Administer policy management software (PolicyTech), including user training and support, configuration, liaising with the vendor, conducting audits and creating performance dashboards.
• Use technology to create and maintain a shared email inbox, trackers, and libraries for policy management and related communications, in order to monitor timeliness and compliance.
• Develop professional, working relationships with external partners and internal stakeholders.
• Act as a point of contact for policies, communicating broadly with staff to keep them up to date on policy program requirements/changes as well as regulatory responsibilities as they pertain to policies.
• Analyze operational functions and associated policies to identify and make recommendations for the creation of, improvement upon, or consolidation of policies to improve oversight for high quality care and compliance. Ensure the existence of policies for all high-risk health plan functions and corporate control functions.
• Identify opportunities for process improvement.
• Provide backup for other staff on the Regulatory Affairs Team.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years’ administrative experience, including 1 year experience in a compliance or regulatory role

Preferred

• Experience coordinating or managing a policy program
• Experience in a health care or managed care setting with a background in Oregon Health plan (Medicaid) and the Centers for Medicare and Medicaid Services (CMS)
• Project coordination experience

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of principles of corporate controls, standards, risk mitigation
• Knowledge of or ability to learn and understand managed health care operations and remain abreast of standards, especially those relating to external audits and regulatory submissions
• Knowledge of or ability to learn project coordination skills

Skills and Abilities

• High degree of technical writing skill
• Ability to research, interpret and communicate federal and state requirements relating to Medicaid and Medicare compliance, including the Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules
• Competency with computer software programs, e.g. MS Outlook, Word, Excel, and PowerPoint, Adobe, Visio, Smartsheet
• Strong engagement and partnership skills, including written and verbal communication with a broad array of stakeholders, including presentations of data and moderately complex processes as needed to internal stakeholders
• Strong organizational and documentation skills in order to prepare clear, concise, and objective reports as indicated by functional area
• Strong attention to detail
• Ability to identify work goals with manager and prioritize work to balance competing deadlines in a professional manner, while managing multiple tasks
• Ability to work independently with a high degree of initiative and motivation
• Ability to work in a confidential manner with partner, member, and provider information
• Ability to work as a member of a team in a collaborative manner

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.