Registered Nurse Medical Policy Manager
Company: VirtualVocations
Location: Washington
Posted on: February 1, 2025
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Job Description:
A company is looking for a Medical Policy Manager for Behavioral
Health Services.
Key Responsibilities:
Researches scientific evidence and guidelines for behavioral health
services and collaborates with clinical teams to update clinical
review criteria
Reviews and documents revisions to medical policies, ensuring
compliance with NCQA guidelines and regulatory requirements
Coordinates external policy reviews and presents recommendations to
the Utilization Management Committee
Required Qualifications and Education:
Bachelor's degree in nursing or equivalent combination of education
and experience
6 years of experience in a managed care setting, including
utilization management
Knowledge of coding essential; Certified Professional Coder (CPC)
preferred
Registered nurse with a current active license preferred; other
licensed allied health care professionals considered
5+ years of clinical experience in behavioral health services
preferred
Keywords: VirtualVocations, Washington DC , Registered Nurse Medical Policy Manager, Healthcare , Washington, DC
Click
here to apply!
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