Health Services Professional
| Company | CVS Health |
|---|---|
| Location | Washington, USA, Oregon, USA, Texas, USA, Florida, USA, Arizona, USA, Rhode Island, USA, Illinois, USA |
| Salary | $95738 – $206206 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level, Senior |
Requirements
- Minimum three years’ experience with clinical policy creation
- Minimum one year experience with medical writing
- Minimum one year experience with PubMed database search engine for accessing published, peer-reviewed medical literature
- Evidence-based medicine and health technology assessments
- Understanding of methodological principles of clinical study design and statistical methods used in clinical research
Responsibilities
- Respond to questions from medical directors and other clinical staff on clinical policy issues
- Drafting new clinical policies and revise existing clinical policies and present those revisions to Clinical Policy Council
- Periodically update existing clinical policies
- Review evidence submissions from product manufacturers and providers
- Ad hoc projects and administrative tasks as needed
- Conduct rapid reviews using PubMed and other relevant clinical evidence resources to identify evidence relevant to the safety and effectiveness of a clinical intervention, identify the highest quality evidence, summarize the results of each of those studies, and reach conclusions about the overall quality of evidence in support of the intervention
- Research and provide rapid responses to clinical questions from Aetna medical directors or other clinical staff regarding the medical necessity and experimental and investigational status of interventions that are eligible for coverage under Aetna medical plans, considering published evidence, systematic evidence reviews, clinical practice guidelines, consensus statements, and technology assessments
- Develop and update clinical policies (CPBs) on the experimental and investigational status and medical necessity of technologies eligible for coverage under Aetna medical plans, as well as clinical criteria for their use
- Candidate is required to have regular and predictable attendance
- Candidate will be required to complete any additional tasks as directed by supervisor or manager
Preferred Qualifications
- Minimum eight years’ experience with clinical policy creation
- Prior relevant work experience related to evidence-based clinical policy development
- Broad knowledge of clinical medicine, including drugs, biologics, devices, surgical procedures, tests, and therapies
- Basic understanding of commercial health insurance and Medicare and Medicaid programs
- Basic understanding of the regulatory environment for medical technologies, including the FDA approval process and Medicare coverage determinations
- Basic understanding of the system of standardized codes used in the billing and tracking of healthcare services to report a patient’s medical diagnosis (ICD-10 diagnosis codes) and the medical procedures performed on them (CPT and HCPCS procedure codes)