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Medical Policy Jobs (NOW HIRING)

Caris Life Sciences

Director - Medical Policy

Position Summary The Director of Medical Policy will manage Market Access strategies for current and pipeline products and drive payer and health policy initiatives for the Caris Life Sciences ...

Cotiviti

Client Policy Manager I

$110K - $119K/yr

Primarily responsible for the integrity of the client's medical policy set, including awareness of all client-related Medical Policy project requests, monthly review of Max Units, review of Health ...

Akron Children's Hospital

Payer Policy Coordinator

Akron, OH · On-site

$18.50 - $24.75/hr

The Payer Policy Coordinator is responsible for the end-to-end coordination of payer medical policy review and communication processes for Akron Children's. This role proactively monitors, analyzes ...

Lthc

Medical Director, Commercial

Jamestown, VA · On-site

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

Lthc

Medical Director, Commercial

Dewitt, MI

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

Lthc

Medical Director, Commercial

Dewitt, MI · On-site

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

Lthc

Medical Director, Commercial

Utica, NY

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

Lthc

Medical Director, Commercial

Rochester, NY

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

Lthc

Medical Director, Commercial

Binghamton, NY · On-site

The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees ...

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Medical Policy information

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$79.5K

$117.5K

$190K

How much do medical policy jobs pay per year?

As of Jul 22, 2026, the average yearly pay for medical policy in the United States is $117,469.00, according to ZipRecruiter salary data. Most workers in this role earn between $86,000.00 and $150,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced by professionals working in medical policy development?

Professionals in medical policy often encounter challenges such as interpreting complex clinical evidence, balancing regulatory requirements with organizational goals, and addressing the diverse needs of stakeholders including clinicians, patients, and payers. They must also stay up-to-date with rapidly evolving medical technologies and guidelines, which can impact existing policies. Effective communication and collaboration across multidisciplinary teams are essential to ensure policies are evidence-based, practical, and aligned with both legal and ethical standards.

What is the difference between Medical Policy vs Medical Claims Specialist?

AspectMedical PolicyMedical Claims Specialist
Required credentialsTypically healthcare or insurance-related certifications, degrees in health administration or related fieldsLikewise, certifications in insurance processing or healthcare administration often preferred
Work environmentOffice settings, insurance companies, healthcare organizationsOffice environments, insurance companies, healthcare providers
Employer and industry usageUsed by insurance companies, healthcare organizations to develop coverage guidelinesUsed by insurance companies, healthcare providers to process and adjudicate claims

Medical Policy professionals focus on creating and managing coverage guidelines, while Medical Claims Specialists handle the processing and reimbursement of healthcare claims. Both roles are essential in the healthcare insurance industry but serve different functions within the claims and coverage process.

What is a Medical Policy?

A medical policy is a set of guidelines developed by health insurance companies or healthcare organizations to determine the medical necessity, appropriateness, and coverage of healthcare services and treatments. These policies help ensure that patients receive evidence-based care and that coverage decisions are consistent and fair. Medical policies are typically based on clinical research, expert consensus, and regulatory standards. They are regularly reviewed and updated to reflect advances in medical knowledge and changing healthcare regulations.

What are the key skills and qualifications needed to thrive in Medical Policy, and why are they important?

To thrive in Medical Policy, you need a strong understanding of healthcare regulations, clinical guidelines, and policy analysis, often supported by a degree in healthcare administration, public health, or a related field. Familiarity with data analysis tools, medical coding systems (such as ICD-10 or CPT), and healthcare compliance software is typically required. Excellent analytical thinking, communication, and collaboration skills help professionals interpret complex information and work with diverse stakeholders. These skills are crucial for ensuring that medical policies are evidence-based, regulatory compliant, and effectively support organizational and patient outcomes.
More about Medical Policy jobs
What cities are hiring for Medical Policy jobs? Cities with the most Medical Policy job openings:
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What job categories do people searching Medical Policy jobs look for? The top searched job categories for Medical Policy jobs are:
Medical Policy jobs near you
Infographic showing various Medical Policy job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $117,469 per year, or $56.5 per hour.
Director - Medical Policy

Director - Medical Policy

Caris Life Sciences

Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Job description

At Caris, we understand that cancer is an ugly word-a word no one wants to hear, but one that connects us all. That's why we're not just transforming cancer care-we're changing lives.
We introduced precision medicine to the world and built an industry around the idea that every patient deserves answers as unique as their DNA. Backed by cutting-edge molecular science and AI, we ask ourselves every day: "What would I do if this patient were my mom?" That question drives everything we do.
But our mission doesn't stop with cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare-driven by innovation, compassion, and purpose.
Join us in our mission to improve the human condition across multiple diseases. If you're passionate about meaningful work and want to be part of something bigger than yourself, Caris is where your impact begins.
Position Summary
The Director of Medical Policy will manage Market Access strategies for current and pipeline products and drive payer and health policy initiatives for the Caris Life Sciences product portfolio. This position plays a critical role in shaping and aligning the company's medical policy strategy and will lead tactics and communications in support of influencing reimbursement policies, including coverage and evidence generation for current and pipeline products. This position is responsible for identifying, analyzing and responding to medical policy developments for commercial and government payers and well as Lab Benefit Management (LBM) companies. This position reports to the VP of Market Access, however sits at the intersection of Medical Affairs, HEOR and Government Affairs.
Job Responsibilities
  • Monitor and analyze payer and LBM medical policies, coverage decisions and reimbursement trends across commercial and government payers to assess impact on company pipeline.
  • Interpret payer and policy changes and communicate implications to the broader internal stakeholders.
  • Clinical and product expert for the Market Access team and responsible for presenting clinical data to market access policy makers, including Medical Directors and Medical Policy groups, and meetings and conferences.
  • Own and support the development of evidence generation plans, value propositions and technical assessment submission packages to submit to gain coverage of Caris products to assigned payers and LBM's.
  • Engage with payer stakeholders including Medical Directors and Medical Policy contacts to communicate updates to data and to advocate for coverage of Caris's tests. Maintain policy relationships with industry, including trade associations and professional societies.
  • Support National and State legislative initiatives advocating for coverage of evidence-based biomarkers for all cancer patients to improve access and promote health equality.
  • Market Access representative and advocate in strategic and tactical planning within the business units, focused on evidence generation, product development, and commercialization from a Payer perspective.
  • Partner with market access, marketing, HEOR and other related solutions teams to support the execution of business plans for the business unit.
  • Closely track and understand professional society guidelines and technology assessments that influence payer policy decisions.
  • Ability to work in a deadline-driven and fast-paced environment, including managing multiple projects on time and within budget completion.
  • Ability to use expert knowledge and judgment to make sound decisions.
  • Ability to effectively collaborate, interface, and influence with all levels of an internal organization.
  • Ability to lead, manage, and prioritize strategies, initiatives, and workload independently and proactively in a fast-paced, entrepreneurial environment.
  • Adaptable, open to change, and ability to work in ambiguous situations and respond to new information and unexpected circumstances.
  • Ability to develop a value proposition and effective business case to influence medical policy.
  • Apply outstanding problem solving, project and program management skills.
  • Exercise strong analytical and business skills; ability to communicate effectively with high level executives.
  • Exercise strong collaboration, influencing, project management, organizational, and change management skills.
  • Exercise strong oral and written communication and presentation skills.
  • Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
  • Maintain regular and reliable attendance.
  • Develop and maintain payer engagement strategies to support long-term access and reimbursement goals.
  • Lead internal training sessions to educate commercial and medical teams on payer trends and policy changes.
  • Track and report on key performance indicators (KPIs) related to payer coverage, policy wins, and access milestones.
  • Collaborate with Clinical Development and HEOR to align evidence generation with payer expectations.
  • Support pricing strategy development by providing insights into payer value perception and reimbursement benchmarks.
  • Represent the company at external policy forums, payer advisory boards, and industry coalitions.

Required Qualifications
  • Advanced clinical or scientific degree (e.g., PharmD, PhD, MS in Genetic Counseling, NP, PA, or equivalent).
  • Minimum 7 years of experience in medical policy, market access, or related roles in biotech, diagnostics, or healthcare.
  • Demonstrated experience engaging with payers, including Medical Directors and policy decision-makers.
  • Strong knowledge of U.S. healthcare reimbursement systems, including CMS and commercial payers.
  • Proven ability to develop and communicate evidence-based value propositions.
  • Excellent analytical, communication, and presentation skills.
  • Experience working cross-functionally in a matrixed organization.
  • Deep scientific understanding and practical application of oncology biomarkers and companion diagnostics.
  • Strong understanding of digital health and real-world evidence generation.
  • Ability to communicate technical and non-technical information to scientific and non-scientific colleagues/clients.
  • Strong interpersonal and peer leadership skills to influence without authority.
  • A strategic thinker with excellent verbal, written and presentation skills to get buy-in and drive consensus within the team and the rest of the organization.

Preferred Qualifications
  • 10+ years of experience in market access, medical affairs, or payer engagement.
  • A minimum of 5 years of relevant market access and reimbursement experience; preferably from biotech, medical device, or a molecular diagnostic laboratory.
  • Experience with Lab Benefit Managers (LBMs) and health technology assessments (HTAs).
  • Familiarity with digital health technologies and real-world evidence (RWE) strategies.
  • Prior experience in a leadership or strategic advisory role.
  • Active participation in industry working groups, professional societies, or policy advocacy organizations.
  • Experience supporting legislative or regulatory initiatives related to diagnostics or oncology.
  • Strong competency of the US payer landscape and market drivers.
  • Scientific expert in Comprehensive Genomic Profiling.
  • Highly self-motivated, self-directed, and attentive to detail.
  • Ability to work in a complex and matrix team environment; experience working in a team-oriented, collaborative environment.
  • Proven abilities in leading complex problem management and process analysis.
  • Ability to handle multiple tasks, set priorities, schedule, and meet deadlines.
  • Proven abilities in problem management, process analysis and root cause analysis.
  • Strong interpersonal and relationship-building skills, with the ability to manage up, down and across levels of the organization.

Other
  • Approximately 25% travel and the ability to work flexible hours when required.

Physical Demands
  • This position requires the ability to use a computer keyboard, read printed materials and communicate through email and over telephone.

Annual Hiring Range
$200,000 - $215,000
Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer.
Description of Benefits
  • Highly competitive and inclusive medical, dental and vision coverage options
  • Health Savings Account for medical expenses and dependent care expenses
  • Flexible Spending Account to pay for certain out-of-pocket expenses
  • Paid time off, including: vacation, sick time and holidays
  • 401k match and Financial Planning tools
  • LTD and STD insurance coverages, as well as voluntary benefit options
  • Employee Assistance Program
  • Pet Insurance
  • Legal Assistance
  • Tuition Assistance

Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.
This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

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