Policy Development Analyst - Senior

Job Description:

Essential Functions 

• Leads the research process which includes initial request for policy development or modification through analysis and development of recommended policy to senior management, and implementation of approved policy.
• Develops policies. Considers the fit with organizational goals and strategies, impact on organization's initiatives, long-term marketing strategies, and the amount of clinical input required to determine if the request fits the scope policy process.
• Presents recommendations, answers questions about the analysis as well as impacts and ease of implementation. Presents issues and recommendations based on findings.
• Oversees the implementation of approved policy/product changes and coordinates the efforts of an implementation team with affected management and their functional areas of responsibility.
• Provides support and acts as a resource for projects or teams needing extensive input from a policy specialist.
• Stays current on changes, practices, policies, and all aspects of the business to provide accurate information about benefit quoting and proper adjudication. Learns about policies and procedures associated with each functional area.
• Oversees the coding review process, makes coverage and benefit determinations on each individual code. Implements coding determination changes through documentation, system set up and, if necessary, provider communication.
• Champions and leads initiative for policies requiring change.
• Participates in functional area committees to ensure consistent policy development.
• Assists in other product development activities and projects, such as benefit design research, member satisfaction research and market research, as well as project tracking, prioritization, and other related project management activities.

Minimum Qualifications 

• Four years of policy experience. 
• Two years of experience in a medical benefits or insurance setting, or other related work experience to gain a good understanding of claims and eligibility issues, basic medical coding expertise, and insurance product knowledge. 
• Experience managing projects that require strong interpersonal and organizational skills and the ability to perform under stress and to meet deadlines. 
• Excellent oral, written, and interpersonal communication skills. 
• Intermediate skills in computer-based word processing and spreadsheets

Preferred 

• Bachelor's Degree in a business or healthcare related field. 
• Four years of project management experience in a regulatory or insurance setting. 
• Demonstrated intermediate knowledge with claims adjudication systems. 
• Strong organizational, data gathering, and data analysis skills. 
• Excellent problem solving, negotiation, and process improvement skills.  
• Experience with policy, research, operations or analytics within a pharmacy or PBM setting
• Experience with medication-centric utilization management or formulary management platforms and applications (including knowledge of pharmacy benefit configuration and/or claims adjudication)
• Familiarity with regulatory and industry standards (such as NCPDP) and demonstrated understanding of formulary and benefit design, prior authorization, step therapy, quantity limit, and other drug utilization rules

Skills 

• Health Care Regulation 
• Communication
• Project Management 
• Decision Making 
• Attention to Detail 
• Analytical Thinking 
• People Management 
• Cultivates Necessary Relationships 
• Initiative 
• Accountability

Physical Requirements 

• Ongoing need for employee to see and read information, documents, monitors, and be able to assess internal customer needs. 
• Frequent interactions with colleagues, that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. 
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. 
• Expected to stand or sit in a stationary position at a desk for an extended period of time. 

Location:

Work City:

Work State:

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.