Medical Policy Consultant

3 weeks ago

Harrisburg, United States Elevance Health Full time

Medical Policy Consultant

National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

Location: This is a virtual position, and preferred candidates reside within 50 miles of an Elevance Health PulsePoint location.

Shift: Monday - Friday 8 am - 4:30 pm EST.

The Medical Policy Consultant is responsible for researching and drafting NGS Medical Policy ensuring the use of valid and consistent research methodologies.

How you will make an Impact:

  • Conducts structured research within defined methodologies.

  • Drafts and modifies policies using consistent template tools and criteria.

  • Review new and updated codes for accuracy and consistency.

  • Research relevant studies and review articles for the development of local coverage determinations, coverage articles, and coding guidelines and for responses to inquiries from providers.

  • Finalizes issues and ensures implementation of these policies.

  • Works with other internal areas and with the Medical Directors to respond to internal and external requests that seek written clarification of a general or specific policy question. The response may be a reiteration of an established policy a redefinition of the current policy or research to determine a new revised policy.

  • Attendance and understanding of edits via the Edit Effectiveness meetings is a critical skill.

  • Ability to think on your feet and learn the policy consultant job quickly.

  • Scheduling Open Meetings/CACs and informal meeting processes must be learned.

  • Review and respond to OIG, CMS questions, and FOIA requests in a timely fashion.

  • Must be able to formulate a written policy in collaboration with Medical Directors and attend workgroup meetings and weekly CMD/MPU meetings. This must be based on significant research using Hayes and other tools available to the policy team.

Minimum Requirements:

  • Requires a BA/BS degree in a related field and a minimum of 2 years related experience; or any combination of education and experience which would provide an equivalent background.

  • Travels to worksite and other locations as necessary.

  • Working knowledge of coding is required.

  • This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities, and Experiences:

  • RN license is preferred.

  • Prior medical literature research experience or related experience is preferred.

  • Technical writing experience preferred.

  • Excellent writing and communication skills and attention to detail as well as a love of research.

  • In-depth knowledge of ICD-10, CPT, and HCPCS codes is preferred.

  • Understanding edits/audits in FISS and MCS is preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role-specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. The use of this job is limited to the Federal Government Services business unit.

  • Transportation Policy Specialist

    2 months ago

    Harrisburg, United States Michael Baker International Full time

    **DESCRIPTION** Michael Baker International’s Harrisburg, PA office is seeking a Transportation Policy specialist to assist its Planning Department on assignments for the Pennsylvania Turnpike Commission. This position will deliver innovative technical planning, policy and finance services to the Pennsylvania Turnpike Commission, Pennsylvania Department...

  • Lactation Consultant, UPMC Harrisburg, Lactation Services.

    2 weeks ago

    Harrisburg, United States UPMC - Pittsburgh Medical Center Full time

    Job DescriptionPurpose:Provides optimal breastfeeding management.Responsibilities:Conduct clinical lactation rounds assessing patients' status and problems and develop individualized care plans.Conduct clinical training of professional, nursing and ancillary staff.Participate in discharge planning by identifying post-discharge needs and providing...

  • Audit Consultant

    3 weeks ago

    Harrisburg, United States Manpower Group Inc. Full time

    Jefferson Wells is working with one of our Central PA clients to identify an Internal Audit Consultant! T **Internal Audit Consultant (Financial/Operational Controls):** **Location: Central, PA, Western, PA and Eastern, PA** **Pay Range: $55-75** **+** **/hr. W2 (depending on experience)** **What's the Job?** + Performing financial and operational audits of...

  • Audit Consultant

    1 week ago

    Harrisburg, United States Manpower Group Inc. Full time

    Jefferson Wells is working with one of our Central PA clients to identify an Internal Audit Consultant! T **Internal Audit Consultant (Financial/Operational Controls):** **Location: Central, PA, Western, PA and Eastern, PA** **Pay Range: $55-75** **+** **/hr. W2 (depending on experience)** **What's the Job?** + Performing financial and operational audits of...

  • Lactation Consultant, UPMC Harrisburg, NICU.

    1 month ago

    Harrisburg, United States UPMC Full time

    Purpose: Provides optimal breastfeeding management. Responsibilities: Conduct clinical lactation rounds assessing patients' status and problems and develop individualized care plans. Conduct clinical training of professional, nursing and ancillary staff. Participate in discharge planning by identifying post-discharge needs and providing breastfeeding...

  • Lactation Consultant, UPMC Harrisburg, NICU.

    2 weeks ago

    Harrisburg, United States UPMC Full time

    Purpose: Provides optimal breastfeeding management. Responsibilities: Conduct clinical lactation rounds assessing patients' status and problems and develop individualized care plans. Conduct clinical training of professional, nursing and ancillary staff. Participate in discharge planning by identifying post-discharge needs and providing breastfeeding...

  • Lead Medical Laboratory Scientist

    1 month ago

    Harrisburg, United States UPMC - Pittsburgh Medical Center Full time

    Job DescriptionPurpose:This position assists the Laboratory Supervisor by monitoring the work of technical and ancillary employees. The Lead Medical Technologist assists in test development, gathering data for management reports and regularly performs the duties of a Medical Technologist, including the accurate performance of routine and advanced testing....

  • Lead Medical Laboratory Scientist

    2 weeks ago

    Harrisburg, United States UPMC - Pittsburgh Medical Center Full time

    Job DescriptionPurpose:This position assists the Laboratory Supervisor by monitoring the work of technical and ancillary employees. The Lead Medical Technologist assists in test development, gathering data for management reports and regularly performs the duties of a Medical Technologist, including the accurate performance of routine and advanced testing....

  • Lactation Consultant, UPMC Harrisburg, NICU.

    1 month ago

    Harrisburg, United States UPMC Life Changing Medicine Full time

    Purpose:Provides optimal breastfeeding management.Responsibilities:Conduct clinical lactation rounds assessing patients' status and problems and develop individualized care plans.Conduct clinical training of professional, nursing and ancillary staff.Participate in discharge planning by identifying post-discharge needs and providing breastfeeding instruction,...

  • Lactation Consultant, UPMC Harrisburg, NICU.

    2 weeks ago

    Harrisburg, United States UPMC Life Changing Medicine Full time

    Purpose:Provides optimal breastfeeding management.Responsibilities:Conduct clinical lactation rounds assessing patients' status and problems and develop individualized care plans.Conduct clinical training of professional, nursing and ancillary staff.Participate in discharge planning by identifying post-discharge needs and providing breastfeeding instruction,...

  • Vascular Consultant

    1 month ago

    Harrisburg, United States Boston Scientific Corporation Full time

    The Peripheral Vascular Consultant position requires someone with strong clinical aptitude that can excel in a team environment. Key responsibilities include developing new accounts and expanding usage of company products within existing accounts to Consultant, Clinical Research, Sales, Healthcare, Manufacturing, Hospital, Medical

  • Associate Medical Director

    3 weeks ago

    Harrisburg, United States Hospice of Central PA Full time

    Oversee, coordinate and review the medical care provided to hospice patients in order to ensure pain and symptom management control, minimize the risk of polypharmacy and assure patient goals of care are in line with hospice philosophy. Certify and recertify client eligibility for hospice care in accordance with applicable Medicare Hospice regulations and...

  • Adult Consult Psychiatrist

    1 month ago

    Harrisburg, United States Pinnacle Health Systems Full time

    Job Summary The Staff Psychiatrist is responsible for providing psychiatric diagnosis, evaluations, and treatment to assigned patients on the Inpatient Behavioral Health Unit, either by direct patient care or supervision of other staff in the provision of care.# The Psychiatrist will provide treatment or consult in selected cases that are unusual or...

  • Adult Consult Psychiatrist

    2 weeks ago

    Harrisburg, United States Pinnacle Health Systems Full time

    Job Summary The Staff Psychiatrist is responsible for providing psychiatric diagnosis, evaluations, and treatment to assigned patients on the Inpatient Behavioral Health Unit, either by direct patient care or supervision of other staff in the provision of care.# The Psychiatrist will provide treatment or consult in selected cases that are unusual or...

  • Leasing Consultant

    3 weeks ago

    Harrisburg, United States Property Management Enterprises LLC Full time

    Job DescriptionJob DescriptionWe are currently recruiting for a full-time Leasing Consultant to join our team in Harrisburg, PA for The Apartment Gallery of Harrisburg servicing Beaufort Manor, Colonial Glen, Paxton Park and Crooked Hill Townhomes.Requirements:· High school diploma or equivalent· Basic proficiency in computer technology including Word,...

  • Leasing Consultant

    2 weeks ago

    Harrisburg, United States Property Management Enterprises LLC Full time

    Job DescriptionJob DescriptionWe are currently recruiting for a full-time Leasing Consultant to join our team in Harrisburg, PA for The Apartment Gallery of Harrisburg servicing Beaufort Manor, Colonial Glen, Paxton Park and Crooked Hill Townhomes.Requirements:· High school diploma or equivalent· Basic proficiency in computer technology including Word,...

  • Sales and Leasing Consultant

    2 weeks ago

    Harrisburg, United States Turner Kia Full time

    **Responsibilities** - Nurture enriching relationships to build clientele for life. - Exhibit consultative selling skills. Assist customers in selecting a vehicle by asking questions and listening carefully to their responses. - Continuously develop product and sales acumen to become the vehicle authority. Know the in’s and the out’s of product...

  • Utilization Management Nurse Consultant

    2 weeks ago

    Harrisburg, United States CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

  • Utilization Management Nurse Consultant

    3 weeks ago

    Harrisburg, United States CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

  • Utilization Management Nurse Consultant

    2 weeks ago

    Harrisburg, United States CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...