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Registered Nurse Medical Policy Manager

Company: VirtualVocations
Location: Washington
Posted on: February 1, 2025

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

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