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Medical Policy Jobs (NOW HIRING)

Prevailance

Senior Staff Medical Assistant

Tampa, FL · On-site

The role includes medical policy analysis, health protection integration, medical readiness support, and limited clinical care to maintain privileges and competency. This position requires a ...

Valenz

Medical Director - Part Time

Phoenix, AZ · Remote

You'll help ensure clinical decisions, medical policies, and review processes align with evidence-based medicine, regulatory requirements, and organizational standards. In this role, you'll support ...

WellSense Health Plan

Medical Director

MA · On-site +1

$173K - $250K/yr

The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and ...

Mutual of Omaha

VP & Medical Director

Omaha, NE · On-site +1

$201K - $320K/yr

Underwriting, Leadership As our VP & Medical Director, you'll shape medical policy, oversee complex case reviews, and guide strategic decisions that support sound risk management and high-quality ...

Geisinger Health

Medical Director Medicaid

Danville, PA · On-site +1

Provide clinical direction for the Medicaid product, including medical policy, clinical guidelines, and care model design across UM/CM/DM. * Provide physician leadership for utilization management ...

Threat Tec, LLC

Medical Planner

Tampa, FL · On-site

$175K - $195K/yr

Involved with Medical Policy & Planning Support * Serve as a subject‑matter expert to the MARCENT Force Surgeon on medical policies issued by CENTCOM , BUMED , and DHA ; interpret guidance and ...

Threat Tec

Medical Planner

Tampa, FL · On-site

This role combines strategic policy advising with limited clinical duties to maintain privileges and readiness. Key Responsibilities * Involved with Medical Policy & Planning Support * Serve as a ...

Ourhrconnect

May also write and revise medical policies. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours ...

Ourhrconnect

May also write and revise medical policies. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours ...

Ourhrconnect

May also write and revise medical policies. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours ...

Logix Guru

Medical Director

The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on ...

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Showing results 21-40

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Medical Policy information

See salary details

$79.5K

$117.5K

$190K

How much do medical policy jobs pay per year?

As of Aug 12, 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:
What states have the most Medical Policy jobs? States with the most job openings for Medical Policy jobs include:
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 August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $117,469 per year, or $56.5 per hour.

RN Medical Coverage Policy Consultant

HealthPartners

Bloomington, MN • On-site

$39.73 - $59.59/hr

Full-time

Medical, Retirement

Re-posted 9 hours ago

HealthPartners rating

7.5

Company rating: 7.5 out of 10

Based on 134 frontline employees who took The Breakroom Quiz

235th of 887 rated healthcare providers

Job description


HealthPartners 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.
MINIMUM QUALIFICATIONS:
  • 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

PREFERRED QUALIFICATIONS:
  • 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.

ESSENTIAL DUTIES:
  1. (15%) Research, identify, analyze and evaluate evidence based scientific literature and use critical thinking skills to summarize and synthesize evidence-based findings, complex clinical information and technical information which affect medical coverage policies and benefits.
  2. (15%) Develops professional documents which summarize scientific literature and administrative research as support for health plan coverage positions. Delivers verbal and written presentations.
  3. (10%) Research and interpret benefit coverage across all health plan products including Commercial, Medicare, Medicaid and employer groups. Identifies and applies health plan benefit variances in coverage from product to product and state to state. Researches and complies with applicable laws, CMS requirements, regulatory and accreditation standards to support departmental initiatives and incorporate into coverage policy work.
  4. (10%) Reviews and summarizes informatics and claims reports to understand volume, costs and coding implications to support policy implementation and maintenance.
  5. (10%) Develops and revises coverage criteria policies including evidence-based, administrative policies and benefit supplemented policies, which support medical directors and leaders in designing medical coverage policy strategy.
  6. (15%) Accountable for successful implementation of all assigned work. Collaborates with other departments as needed; prepares implementation plans; identifies and implements claims edits related to coverage policies; facilitates completion and resolves critical implementation issues.
  7. (10%) Communicates coverage policy interpretation, explanation and rationale for coverage positions and implementation approach to providers, members, outside vendors, employer groups and internal departments.
  8. (15%) Provides staff support for various committees, administrative work, evolving departmental work, and other duties as assigned.

#LI-Hybrid
About Us
At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total HealthAs a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.

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