Analysis Skills, Communication Skills, Continuous Improvement, County Ordinances, Dental Insurance, Detail Oriented, Documentation, Documentation Standards, Funding, Medical Office Administration, Multitasking, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Regulatory Compliance, Reporting Skills, Request for Information (RFI), Requirements Management, Retail, Root Cause Analysis, State Laws and Regulations, Strategic Planning, Trend Analysis, Usability Engineering, User Interface/Experience (UI/UX), Vision Plan, Writing Skills
Medical Policy Strategy Specialist - Fully Remote (MN Residents Only)
Position Summary
We are seeking an experienced professional to lead the alignment of coverage guidelines, evaluation tools, and internal processes that support successful approval and payment outcomes. This role serves as a subject matter expert in documentation requirements and policy interpretation, translating complex external guidelines into practical tools that improve approval rates while simplifying report writing for clinicians.
Working closely with cross‑functional partners, this individual will analyze approval and denial trends, identify root causes, and lead continuous improvement initiatives that enhance compliance, consistency, and ease of use. The ideal candidate balances analytical rigor with a strong commitment to supporting clinicians and improving access for the people they serve.
Key Responsibilities
- Analyze coverage requirements and approval criteria to ensure internal evaluation tools and documentation standards are properly aligned
- Lead the development, implementation, and ongoing optimization of evaluation tools that support medical justification
- Monitor authorization and payment outcomes to identify trends, recurring issues, and opportunities for improvement
- Develop proactive strategies to reduce repeat denials and minimize requests for additional information
- Translate complex, policy‑driven requirements into clear, easy‑to‑use guidance for clinicians
- Partner with internal teams to ensure evaluation processes support both compliance and a positive user experience
- Serve as an internal expert on documentation standards and approval expectations
- Establish and maintain documentation frameworks that improve approval outcomes while reducing administrative burden
- Audit evaluation outputs regularly to ensure quality, consistency, and alignment with current requirements
- Stay current on changes that may impact approval or funding outcomes and adjust processes accordingly
- Support broader initiatives aimed at improving the end‑to‑end funding and approval process
- Promote a culture focused on continuous improvement, clinician support, and access
- Perform other related duties as needed
Core Skills & Competencies
- Strong analytical ability with experience interpreting complex external requirements
- Ability to translate detailed rules into practical, user‑friendly workflows
- Experience working cross‑functionally and influencing outcomes without direct authority
- Comfort balancing compliance requirements with usability and efficiency
- Strong problem‑solving and root‑cause analysis skills
- Excellent written and verbal communication skills
- Highly organized, detail‑oriented, and self‑directed
- Ability to manage multiple priorities in a fast‑paced environment
Qualifications
- Bachelor's degree required; advanced degree or clinical background preferred
- 5+ years of experience in policy interpretation, funding processes, or related fields
- Proven experience supporting approval or authorization workflows
- Experience developing or improving evaluation tools or documentation frameworks strongly preferred
- Familiarity with clinician‑facing processes is a plus
Contract Benefits (During Temp Period)
- Medical coverage with prescription benefits and virtual care options
- Hospital indemnity coverage
- Dental and vision insurance
- Accident and critical illness coverage
- Life insurance and short‑term disability (20+ hours per week)
- Earned safe and sick time per local/state guidelines
- Discount programs for travel, entertainment, and retail
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.
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Ultimate Staffing Services