Health Plan Policy Specialist

Overview

: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

Responsibilities

• Research and draft medical, administrative, and reimbursement policies based on clinical evidence, regulatory requirements, and industry standards.
• Ensure policies align with company guidelines, NCQA standards, and applicable laws.
• Collaborate with internal stakeholders to review and approve policies.
• Monitor legislative and regulatory changes impacting health plan policies.
• Support governance committees for policy review and approval.
• Maintain accurate documentation and version control of all policies.
• Provide subject matter expertise for policy interpretation and application.
• Assist in remediation of gaps in existing processes related to policy compliance.
• Respond to inquiries regarding policy requirements.

Knowledge / Skills / Abilities

• Strong analytical and technical writing skills.
• Knowledge of healthcare economics, reimbursement practices, and regulatory compliance.
• Proficiency in Microsoft Office and policy management tools.

Qualifications

Required

• Bachelor's degree in a related field or equivalency.
• Three years of health plans, policy development & maintenance, healthcare, and/or compliance.
• Demonstrated intermediate skills in internet database searches.

Qualifications (Preferred)

• Bachelor's degree in a clinical science (. nursing, medical technology), or health related field, or the equivalency.
• Certified professional coder.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position may involve standing or sitting for long periods of time and is not exposed to adverse environmental conditions.

Physical Requirements Carrying, Lifting, Listening, Pulling and/or Pushing, Sitting, Speaking, Standing

Multi-lingual Candidates Welcomed

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