Anthem, Inc. Medical Policy Analyst Sr in Reston, Virginia
SHIFT: Day Job
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Location: Remote Based
The Medical Policy Analyst Sr. (Milliman Clinical Guidelines) will be primarily responsible for the review and customization of MCG guidelines and development and review and maintenance of Anthem medical policies and clinical UM guidelines.
How will you make an impact:
Perform review of MCG guidelines to identify clinically significant and operationally relevant changes by MCG
Complete review and research for customizations to MCG guidelines, including customizations to MCG clinical criteria based on relevant scientific evidence or reference to an Anthem, AIM or other document
Assist in the audit and testing of updates to MCG guidelines as published on Static CareWeb and other platforms as needed, e.g., Cite Guideline Transparency, backup website
Conduct structured research within defined methodologies and analyzes relevant studies and articles to support analysis of potential new medical policies and clinical UM guidelines
Draft new and modifies existing Anthem medical policies and clinical UM guidelines using standardized templates, criteria, and processes
Review new and updated codes for applicability to existing Anthem documents or potential new topics
Assist in drafting written responses to inquiries from internal and external stakeholders regarding medical policies, clinical UM guidelines, and MCG guidelines
Requires a BA/BS in a related field; 5 years of clinical nursing experience or 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.
Clinical and/or basic science research experience.
Working knowledge of coding.
Preferred Skills, Capabilities and Experiences:
A Nursing degree or MPH is preferred.
Any education in epidemiology is a plus.
Extensive experience with scientific and general writing, reading and critically analyzing scientific literature is strongly desired.
Experience and familiarity with MCG guidelines highly preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.