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Health Policy Administration Jobs in Raleigh, NC

UNC-Chapel Hill

Adjunct Faculty

Chapel Hill, NC · On-site

... health, public policy, law (i.e., Juris Doctorate), public administration, government, social work, nursing, medicine, or a related field Preferred Qualifications, Competencies, and Experience

UNC-Chapel Hill

Adjunct Faculty

Chapel Hill, NC

... health, public policy, law (i.e., Juris Doctorate), public administration, government, social work, nursing, medicine, or a related field Preferred Qualifications, Competencies, and Experience

Mayne Pharma

Compliance Operations Manager

Raleigh, NC · On-site

... training, policy administration, and investigations to help ensure compliance with applicable healthcare laws, regulations, and company policies. The position reports to the VP, Global Head ...

City of Durham

Microsoft Identity Administrator

Durham, NC · Hybrid

$79K - $122K/yr

... policy administration. The Microsoft Identity Administrator also functions as the lead for identity ... Monitor Entra Connect Health dashboards and proactively address replication or connectivity issues.

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All JobsHealth Policy Administration JobsHealth Policy Administration Jobs in Raleigh, NC

Health Policy Administration information

See Raleigh, NC salary details

$55.9K

$106.5K

$126.4K

How much do health policy administration jobs pay per year?

As of Aug 9, 2026, the average yearly pay for health policy administration in Raleigh, NC is $106,514.00, according to ZipRecruiter salary data. Most workers in this role earn between $105,000.00 and $113,200.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed for health policy administration?

To thrive in Health Policy Administration, you need expertise in healthcare systems, policy analysis, public health principles, and often a relevant bachelor's or master's degree. Familiarity with data analysis software, healthcare regulatory databases, and project management tools is commonly required. Strong communication, stakeholder engagement, and problem-solving abilities help professionals excel in this field. These competencies ensure effective development, implementation, and evaluation of policies that improve healthcare quality and efficiency.

What does a health policy administration do?

A health policy administrator develops, implements, and manages policies that influence healthcare delivery and regulation. They analyze healthcare laws, coordinate with stakeholders, and ensure compliance with regulations, often using data analysis and policy research skills. Their work supports the improvement of healthcare systems and access to quality care.

What is health policy administration?

A Health Policy Administration job involves managing, analyzing, and implementing healthcare policies to improve systems and services. Professionals in this field work in government agencies, hospitals, insurance companies, and nonprofit organizations to ensure compliance with regulations and enhance healthcare accessibility. They may conduct research, develop policy recommendations, and collaborate with stakeholders to address public health challenges. Strong analytical, leadership, and communication skills are essential for success in this role.

What can you do with a health policy administration degree?

A health policy administration degree prepares individuals for roles such as health policy analyst, healthcare administrator, or health services manager. Graduates can work in government agencies, healthcare organizations, or consulting firms, often utilizing skills in policy analysis, healthcare systems, and regulatory compliance.

What does a health policy administrator do?

A typical day in Health Policy Administration often involves researching healthcare regulations, analyzing data to assess the impact of existing policies, and developing recommendations for new policies or improvements. Professionals may attend meetings with stakeholders, collaborate with public health officials, and prepare reports or briefing materials for organizational leadership. The role requires balancing administrative tasks with strategic planning, often working closely with both internal teams and external partners. This dynamic environment offers opportunities to shape health policy, influence decision-making, and contribute to meaningful change in the healthcare system.

What are popular job titles related to Health Policy Administration jobs in Raleigh, NC? For Health Policy Administration jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Health Policy Administration jobs in Raleigh, NC look for? The top searched job categories for Health Policy Administration jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Health Policy Administration jobs? Cities near Raleigh, NC with the most Health Policy Administration job openings:
Health Policy Administration jobs near you
Infographic showing various Health Policy Administration job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $106,514 per year, or $51.2 per hour.

Senior Manager, Medical and Clinical Claim Policy and Integration

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • On-site

Full-time

Medical, Vision

Posted 9 days ago

Job description

About The Role
The Senior Manager of Medical and Clinical Claim Policy and Configuration is a senior level decision maker responsible for the content and management of Medical and Claim Policies. Also provides direction and support for system configurations as well as necessary operational assistance to ensure effective policy implementations. This individual will gain broad exposure and work closely with all business units including Medical Management, Network Management, Claims, Operations, IT, Sales and Account Management, and Legal.
*This is a remote role.
Primary Responsibilities
  • Review, update, evaluate and develop medical and clinical claims policies for Commercial medical insurance segment to promote quality, optimize utilization and cost to make them effective for the business.
  • Take responsibility and work closely with Healthcare Economics, Medical Management, Network Management, Claims, Operations, IT, Sales & Account Management, and Legal to implement policies designed to support the effective management of medical expenses and promote quality care.
  • Collaborate with IT and other departments on business and technical requirements involving policies.
  • Develop and maintain Prior Authorization list for Commercial business.
  • Manage Medical and Clinical Claim policy web content and publication.
  • Serve as the subject matter expert for Claims Editing Solution (CES) and lead initiatives involving medical and claim policy including but not limited to CES rules and configuration.
  • Prepares analyses and recommendations for medical policy updates and new code implementation for Medical Director review. Responsibilities include researching applicable CPT/HCPCS/ICD codes, benchmarking industry and payer practices, evaluating benefit and operational impacts, and providing recommendations for code handling, coverage determinations, and benefit integration.
  • Leads the digitization and maintenance of medical policies, including converting policies into electronic formats, configuring policy content within designated systems, ensuring version control and accuracy, and supporting ongoing updates to align with regulatory requirements, business needs, and operational workflows.
  • Maintains and updates JIVA automation code sets, rules, and configurations to support accurate claims processing, utilization management workflows, benefit administration, and medical policy implementation.
  • Work closely with Benefits team in configuration of new clients and working with High Dollar team for coding, PA and benefit questions
Essential Qualifications
  • Expert understanding of Medical Claims operations including medical insurance benefits, medical policy, claims policy, quality assurance, utilization review, and medical cost management.
  • Solid understanding of claim processing including pricing and code editing.
  • Strong organizational and planning skills to manage multiple priorities and meet required deadlines.
  • Good communicator, organized, and able to write clearly
  • Enjoys the challenges associated with decision support algorithms and the attention to detail it requires.
  • This job requires the ability to embed logic in narrative prose and be comfortable with numbers.
  • 5 years' experience in health care administration, managed care, or medical insurance field required
  • 2+ years' experience creating, writing, or managing clinical, claims, or healthcare technical policies and procedures is preferred.
  • Experience working with medical and claims policy reference sources such as CPT/HCPCS/ICD/DRG coding manuals, Specialty Society Guidelines, National Guidelines Clearinghouse materials, CMS and CMS Intermediary policies, and Commercial Health plans policies, among others.
  • Bachelors with an advanced or specialized degree in healthcare, public health, epidemiology, or health policy preferred (Public Health, Pharmacy, Allied Health Professional, Nursing etc.), certified medical coder preferred.
  • Familiarity working with state and federal mandates, and FDA and other regulatory requirements for medical devices, drugs and biologics.
  • Comfortable with Microsoft Word and Excel.

About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all of your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience - how health care is accessed and delivered - by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected]

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