Medical Policy Analyst (Remote)

Over 3.2 million people trust us with their health insurance. We take this responsibility seriously. For generations, CareFirst BlueCross BlueShield has provided security and stability to the members and communities we serve. We believe all people should have access to quality, affordable healthcare and that by working together with our partners, providers and the local community, we will make a meaningful difference in the lives of the people we serve. Today we are faced with an ever-changing landscape, but rather than avoiding change we are committed to leading it forward.

In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted standard of medical practice. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities

Performs in-depth research on medical topics identified in existing medical policies and operating procedures scheduled for revision or updates based upon changes in the standard of care. Evaluates current peer-reviewed articles and other literature to determine its appropriateness of clinical guidance and mandated legislation in support of and inclusion in policies. In collaboration with the Medical Director, revise evidenced-based medical policies and operating procedures in compliance with legislative mandates, contractual provisions, corporate philosophy, and accepted standards of medical practice in order for them to be applied uniformly and consistently across all lines of business. Maintains the Medical Policy Reference Manual (MPRM) including resource files and publications. Ensures dissemination of medical policies and operating procedures to internal and external customers according to CareFirst application protocol and regulatory standards.