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Med Policy Development/Research Specialist

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Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

Perform medical technology research to support the Medical Director Staff and Medical Policy Panel with decisions to ensure that medical policies are consistent with the standards of accepted medical practice in the community.

Job Responsibility:

  • Perform medical technology research related to coverage guidelines and new technology and provide evaluation and summarization to Medical Director Staff and/or Medical Policy Panel
  • Perform medical technology research as requested by other areas of BCBSAZ thru the Medical Policy Referral Form
  • Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel
  • Communicate medical policy information in protocol format to all areas of BCBSAZ requiring this information
  • Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion and, as required, on the Clinical Coding Governance Committee (CCGC)
  • Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies
  • From the direction of management, Medical Director staff or Medical Policy Panel, facilitate external consultant reviews concerning a coverage guideline or new technology
  • Communicate medical policy information in protocol format to healthcare providers upon request
  • With moderate assistance and review by management, perform basic level of code review
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
  • The position has an onsite expectation of 1 day per week and requires a full-time work schedule
  • Perform all other duties as assigned

Requirements:

  • 2 year(s) of experience in clinical field of practice, health insurance, or other health care related field
  • 1 year(s) of experience in medical policy and technology research field (Applies to Level 2)
  • 2 year(s) of experience in medical policy and technology research field (Applies to Level 3)
  • Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN, LPN, LPT, LBSW, LMSW, or LCSW.
  • Intermediate PC proficiency
  • Intermediate Adobe PDF Standard proficiency
  • Intermediate word processing, spreadsheet and presentation software proficiency
  • Maintain confidentiality and privacy
  • Advanced clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities
  • Independent and sound judgment with good problem solving skills

Nice to have:

  • 3 year(s) of experience in clinical field of practice, health insurance, or other health care related field
  • 1 year(s) of experience in claims retrospective review, utilization management, case management, appeals and grievances or quality review field
  • Bachelor's Degree in Nursing or related field of study
  • Active, current, and unrestricted State of Arizona (a state in the United States) license to practice as a Registered Nurse
  • Advanced PC proficiency
  • Advanced Adobe PDF Standard proficiency
  • Advanced processing, spreadsheet and presentation software proficiency
  • Participate in strategic planning
  • Resolve conflicts
  • Represent BCBSAZ in the community

Additional Information:

Job Posted:
January 04, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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