Ncqa Accreditation Consulting Jobs (NOW HIRING)

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

As a member of the Medical Policy Team, the Senior Medical Policy Research Consultant is responsible for participating in development of medical policy strategy and development. This position is responsible for researching and analyzing the medical literature, clinical practice guidelines, and federal and state coverage decisions with the intent of developing medical policies for BCBSM and our national business, and researching new technologies and reviewing existing technologies for presentation to internal technology assessment groups, BCBSM committees and external stakeholders when applicable.

• Develops medical policies for BCBSMN, and assure that changes in medical policies and supporting rationale are communicated to all lines of business, including Medicare, internal stakeholders and others as needed.
• Presents medical policy recommendations and supporting rationale to BCBSMNs Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key groups.
• Participates as a team member in internal BCBSMN technology assessment committees.
• Serve as internal consultant to Medical Directors and staff on emerging medical technology issues.
• Serves as external consultant to providers, vendors, manufacturers, government agencies and other organizations on the technology evaluation and medical policy processes.
• Participates in BCBSMN efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation).
• As part of the Medical Policy Team, researches and analyzes scientific literature and medical policies around a clinical field to develop an organized, strategic approach taking into account the business integration into the policy development process.
• Manage medical policy-related projects.

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Knowledge of medical literature and technology assessment evaluation methods.
• Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, and safety and appropriateness.
• Knowledge of local and national health care environment and trends.
• Ability to work independently, and deliver a product that is defensible before internal and external stakeholders.
• Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms.
• Excellent interpersonal skills.
• Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others.
• Project Management experience.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

• Bachelor's or Masters degree in a health related field with 5 years experience working in a health care environment (e.g. health care policy or clinical guidelines development).
• Knowledge of CPT and ICD-9 coding helpful.

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

$90,800.00 - $120,300.00 - $149,800.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.