Contract
Health System Innovations
Remote
The Medical Policy Manager is responsible for overseeing all cap thresholds and medical review triggers, ensuring they are routed either for administrative evaluation by the vendor or referred to the state’s Utilization Management (UM) vendors for clinical review.
Qualifications
Certified Coding Specialist credential issued by the American Health Information Management Association (AHIMA)
Minimum of five years’ experience creating and administering medical and/or Utilization Management (UM) policies for state Medicaid programs or Medicare
Strong working knowledge of Centers for Medicare & Medicaid Services (CMS) procedure and diagnosis coding, including dental and Current Dental Terminology (CDT) codes
Bachelor’s degree in a related discipline