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Looking for a chance to show what you can do in an environment that will appreciate you and help you grow?  If you are learning-oriented, strive for excellence, and have a strong customer commitment, bring your talents to Independence Blue Cross as we seek to enhance the health and well-being of the people and communities we serve.  As a member of Independence Health Group, we seek to innovate, reimagine and lead in the transformation of healthcare.  We are committed to attracting, retaining and growing the best talent.


The Medical Policy Coordinator is responsible for developing and maintaining medical policies which conform to accepted medical practice standards, researching and developing clinical rationale for annual and quarterly medical code updates, facilitating review and approval of vendor utilization management guidelines, and responding to medical and claim payment policy inquiries.

 

DUTIES AND RESPONSIBILITIES:

 

1.       Develops and maintains new and existing medical policies conforming to accepted medical practice standards and in accordance with evidence-based principles of medicine, Company benefit structure, state and federal mandates and other appropriate sources.

2.    Presents Medical Policy Bulletins to appropriate workgroups and committees and revises documents according to recommendations.   

3.       Researches and develops clinical rationale for annual and quarterly medical code updates.

4.       Facilitates the process for review and approval of vendor utilization management guidelines for select programs and coordinator activities with each vendor.   

5.       Serves as a resource to company associates, and personnel of affiliated companies, by answering clinical inquiries using medical literature, company policy, and other appropriate resources. 

6.       Assists in developing written responses to departmental inquiries.

7.       Establishes goals for assignments in accordance with department and Company operational objectives and seeks feedback on performance. Ensures that assignments are scheduled and completed in an accurate and timely manner.

8.       Maintains detailed knowledge of the status of all assignments and routinely updates the Supervisor, Medical Policy and other members of the management team, as appropriate.

9.       Serves as a liaison to other departments of the Company and represents the department at meetings and on work groups as assigned by management. Leads multidisciplinary workgroups to resolve complex issues as required.

10.   Interacts with all levels of management within the Company and with outside consultants and other organizations.

11.   Performs additional related duties as assigned.


KNOWLEDGE, SKll.LS, AND ABILITIES REQUIRED:

 

1.       Bachelor's degree in nursing or healthcare equivalent work experience. RN licensure preferred; 

2.       Minimum of three years related work experience with evidence of a broad base of clinical knowledge.

3.       Knowledge of FDA regulatory requirements for medical devices, drugs and biologics preferred.

4.       In depth knowledge of all IBC product lines and managed care programs.

5.       Demonstrated ability to manage cross-functional deadline oriented projects to a successful conclusion.

6.       Experience in leading and participating on multidisciplinary workgroups.

7.       Advanced knowledge of word processing, spreadsheet, Internet and e-mail software.

8.       Excellent organizational, time management, presentation, verbal and written communication skills.

9.       Detail oriented with the ability to work with minimal supervision as well as work well with others.

10.   Demonstrated project management skills are preferred.


About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

 

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations.  For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!


Equal Employment Opportunity

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. 

Agency Disclaimer

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process. 

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