RN Medical Coverage Policy Consultant

Health Partners is hiring an RN Medical Coverage Policy Consultant. The Consultant is responsible for the development, maintenance, review, and implementation of medical policies/criteria which support clinical decision-making coverage for services that are rooted in scientific evidence, proven to positively impact healthcare outcomes. This position monitors, reviews and analyzes medical literature for current, new and emerging technology. This position also manages administrative criteria which supplement benefits and third-party resources.

The Consultant is a collaborative position that works with many cross functional departments including Claims, Utilization Management (UM), Medical Directors, Contracts and Benefits, Member Services/Appeals, and Government Programs to support policy changes. The position serves as a content expert related to medical coverage policies and offers continued support to internal and external partners.

This is a hybrid role, with onsite presence required Tuesday through Thursday at the Bloomington 8170 Corporate Office Building. Flexibility, as needed. Schedule and onsite days may be subject to change based on business and team needs.

• Education, Experience or Equivalent Combination:
  • Bachelor's degree in nursing
  • RN with 3-5 years of medical policy experience.
  • Five or more years of healthcare experience, with expertise in the areas of scientific literature research and review, medical guideline development, or coverage policy development
  • Demonstrated health plan implementation experience or knowledge and experience working with health plan operations
• Licensure/ Registration/ Certification:
  • Current Minnesota RN license
• Knowledge, Skills, and Abilities:
  • Technically competent with expertise in creating Microsoft Word and Excel documents
  • Ability to continuously learn new technical skills, competencies, systems or programs
  • Ability to prioritize multiple competing complex tasks, meet deadlines and manage multiple assignments in various stages of development and implementation
  • Ability to plan and organize tasks to complete a project, facilitate collaboration with others and create and manage documentation
  • Ability to work autonomously, deal with ambiguity and respond positively to change
  • Demonstrated effective interpersonal, verbal, and written communication skills
  • Experienced with conducting review and analysis of clinical literature and using critical thinking skills to summarize and synthesize evidence-based findings, complex clinical information and technical information.
  • Displays initiative in identifying problems and outlining possible solutions for review with leaders.
  • Able to identify, understand, and anticipate implications of coverage positions

• Education, Experience or Equivalent Combination:
  • Expertise in medical coding (HCPCS, CPT, ICD-10) related to claims billing, claims processing, and claims implementation strategies
  • Experience in requesting and understanding health plan cost and utilization data
  • Demonstrated skill in collaboration and group facilitation
  • Experience in health plan Utilization Management.
• Licensure/ Registration/ Certification:
  • Current or previous certification in medical coding
• Knowledge, Skills, and Abilities:
  • Expertise in PowerPoint, and Visio
  • Knowledge of, and expertise in Medicare.