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Medical Policy Jobs (NOW HIRING)

Ourhrconnect

$309K - $413K/yr

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

$309K - $413K/yr

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

$309K - $413K/yr

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

$309K - $413K/yr

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

$309K - $413K/yr

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

$309K - $413K/yr

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 ...

Trinityhealth

Medical Director

Saint Francis, KS · On-site

This role provides leadership in medical policy development, supervises Primary Care Providers (PCPs), and collaborates with interdisciplinary teams to ensure optimal care for seniors. What You Will ...

Highmark Health

Medical Director

New York, NY

$385K/yr

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 ...

ARC Group

Medical Research Consultant

Jacksonville, FL · Remote

MEDICAL RESEARCH CONSULTANT REMOTE ARC Group has an immediate opportunity for a Medical Research ... Policy Writing -- 20% o Development of summary and analysis of evidence for inclusion in LCDs to ...

Advantasure, Inc.

Medical Director UM

Detroit, MI · On-site

Responsible for corporate and medical policy interpretation, recommendation, and review within recognized areas of responsibility. Advise and collaborate in the development of clinical programs.

Titan Placement

Medical Director Physician

Hollywood, FL

$300K - $450K/yr

You'll step into an executive leadership role focused on clinical oversight, medical policy, and quality improvement. Why this role is compelling • Competitive executive salary range of $300,000 ...

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All JobsMedical Policy Jobs

Medical Policy information

See salary details

$79.5K

$117.5K

$190K

How much do medical policy jobs pay per year?

As of Jun 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 profession makes $400,000 a year?

In the medical policy field, high-level executives such as Chief Medical Officers or senior healthcare administrators can earn salaries approaching or exceeding $400,000 annually, especially with extensive experience and in large organizations. Physicians in specialized fields like neurosurgery or cardiology also often reach this income level, particularly with private practice or high-volume practices. These roles typically require advanced degrees, certifications, and significant experience.

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 jobs pay 10,000 a month without a degree?

In the medical policy field, high-paying roles such as medical billing managers or healthcare consultants can reach or exceed $10,000 per month with experience and specialized knowledge, often requiring certifications rather than a degree. Outside of medical policy, careers like sales, real estate, or entrepreneurship in healthcare-related services may also achieve this income level without formal degrees, but they typically depend on skills, network, and performance.

What jobs can you get with health policy?

With a background in health policy, you can pursue roles such as health policy analyst, healthcare consultant, policy advisor, or government health official. These jobs often require skills in research, data analysis, and understanding healthcare regulations, and may involve working in government agencies, think tanks, or healthcare organizations.

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 jobs pay 2000 a day?

High-paying jobs that can pay around $2,000 a day typically include specialized medical roles such as surgeons, anesthesiologists, and certain senior healthcare consultants. These positions often require advanced degrees, extensive experience, and certification, and may involve working in private practices or hospitals with high patient volumes or complex procedures.

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

Physical Medicine and Rehabilitation Medical Director

Ourhrconnect

$309K - $413K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description


Summary
 As a member of the senior management team, the Physical Medicine and Rehabilitation Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. 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/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM.

What You'll Do:

  • Supports operations in the form of case review on both medical and regulatory matters.

  • Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures.

  • Educates staff and medical community on various aspects of medical policy and program administration.

  • May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.

  • Develops external relationships with the medical community and serves as liaison between these entities and the contractors.

  • Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.

  • Conducts research into new or controversial medical procedures and technology.

To Qualify for This Position, You'll Need the Following:

  • Required Education: Doctorate in a job related field.

  • Required Experience:

    • 5 years post graduate experience in direct patient care.

  • Required Software and tools: Microsoft Office

  • Required Skills and Abilities:

    • Excellent verbal and written communication skills.

    • Excellent customer service, organizational, and presentation skills.

    • Good judgment skills. Proficiency in spelling, punctuation, and grammar.

    • Ability to persuade, negotiate, or influence others.

    • Ability to work as a team member as well as a leader.

    • Knowledge of medical and utilization review techniques.

  • Required Licenses and Certifications: Active state medical license and current board certification in a recognized specialty.

We Prefer That You Have the Following:

  • Health insurance industry experience

  • Experience in INPATIENT Rehabilitation

  • Medicare policy knowledge and experience

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

  • Subsidized health plans, dental and vision coverage

  • 401k retirement savings plan with company match

  • Life Insurance

  • Paid Time Off (PTO)

  • On-site cafeterias and fitness centers in major locations

  • Education Assistance

  • Service Recognition

  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Pay Range Information:

Range Minimum

$206,011.00

Range Midpoint

$309,767.00

Range Maximum

$413,523.00

Pay Transparency Statement:

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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