Behavioral Health Medical Policy Analyst

• Conducts research involving consistent evidence-based criteria and authorization rules in support of clinical decision making.
• Assists with technical assessment on new medical technologies and procedures.
• Assists in providing full disclosure of medical policies to members and providers through web portals and provider manuals.
• Provides research supplementation for the Special Investigations Unit, identifying instances of fraud, waste and abuse.
• Provides research and criteria to aid legal proceedings regarding clinical policy.
• In partnership with leadership, works with claims, configuration and claims dispute teams to ensure proper implementation of medical policy with the claims system.
• Tracks timelines to ensure timely updates to clinical policies to meet compliance, state, federal and accreditation requirements.
• Supports all annual and "as needed" updates to clinical policy, including Clinical Coverage Guidelines (CCGs), Claims Edit Guidelines (CEGs), and Clinical Practice Guidelines (CPGs).
• Maintains detailed knowledge of all issues concerning medical, pharmacy and behavioral health policy development and maintenance.
• Tracks issues concerning medical, pharmacy and behavioral health policy development and maintenance.
• Provides support to governing committees (e.g., Medical Policy Committee, Claims Payment Policy Committee).
• Participates in cross-functional teams to address key clinical policy issues facing the organization.
• Performs other duties as assigned.Additional Responsibilities:

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act