Medical Policy Research Consultant Senior

For more than 80 years, Blue Cross and Blue Shield of Minnesota has been dedicated to providing quality, cost-effective health plans and unique health programs. We do this through innovation, leadership, community involvement and by staying true to our mission of making a healthy difference in people’s lives.

The Medical Policy Research Consultant Senior is responsible for researching and analyzing the medical literature, clinical practice guidelines, and federal and state coverage decisions with the intent of developing medical policies for BCBSMN and our national business, and researching new and existing medical technologies. This individual presents new and revised medical policies to key committees in the medical policy process such as the Medical Behavioral Health Committee and the executive-level Coverage Committee for approval.

* Develops medical, behavioral health, and medical pharmacy policies for BCBSMN, and assures that policy changes and supporting rationale are communicated to all lines of business, including Government Programs, internal stakeholders and providers. 2. Collaborates with Medical Policy Team members and other stakeholders to develop policies that, incorporate business impact of the policy. 3. Presents medical policy recommendations and supporting rationale to BCBSMN’s Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key stakeholders. Provides training to select stakeholders. 4. Participates as a team member in internal BCBSMN technology assessment, or other cross-department committees. 5. Serves as consultant to Medical Directors, internal stakeholders, providers, vendors, manufacturers, government agencies and other organizations regarding new medical technology issues, the medical technology evaluation and medical policy processes. 6. Participates in BCBSMN efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation). 7. Manages smaller-scale medical policy-related projects.

* Clinical bachelor’s degree working in health care environment (e.g. health care policy or clinical guidelines development) with 3 years experience working in a health care environment (e.g. health care policy or clinical guidelines development). * Knowledge of medical literature search methods. * Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, safety and.effectiveness * Knowledge of local and national health care environment and trends. * Ability to work independently, and deliver a product that is defensible before internal and external stakeholders. * Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms. * Excellent interpersonal skills. * Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others. **Preferred Qualifications** * Master’s degree in a health related field with 5 years’ experience working in a health care environment (e.g. health care policy or clinical guidelines development). * Knowledge of CPT and ICD-10 coding helpful. * Project Management experience