163 applicants

Company

Planned Systems International · 12 hours ago

Policy Analyst/Regulatory Compliance Specialist

United States

Full-time

Remote

Mid, Senior Level

5+ years exp

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Responsibilities

Supports and conducts research activities involving the application of specific policies and regulations to medical conditions. Activities include but are not limited to review and summary of literature and scientific experiments, data preparation and analysis, research design, and assisting with the preparation of manuscripts.

Conduct evidence-based research using support tools such as Up-To-Date, National Comprehensive Cancer Network [NCCN] Guidelines, PubMed/Ovid, and other library-based platforms.

Prepares various communication materials utilizing Word, PowerPoint, Excel and other similar software for a variety of management information reports and project tracking.

Presents analyses and associated recommendations through presentations in a variety of formats to leadership and SMEs. Applies SME/leadership feedback/decision(s) to write final proposals.

Reviews up to 100 certifications on a weekly basis using specific Program criteria.

Plans, develops, implements, and coordinates projects related to the Medical Benefits and Certifications Unit, and specifically the Clinical Consultation Team, of the WTC Health Program throughout the full project life cycle, -including planning, tracking milestones, implementing.

Works across the spectrum of management, communications and operational issues to move special projects and business issues forward. Independently researches and resolves complex issues related to benefits, claim process, regulatory requirements.Analyzes CMS, Tricare, and other federal and private payor program policies and/or operational documents, coverage determinations, and research reports and applies this information to programs decisions.

Develops and maintains knowledge management library, establishing protocol for documenting program decisions and making it searchable and accessible to staff.

Database management including creation, maintenance/management and data entry with close collaboration with Senior Medical Officers, and other clinical staff members.

Performs data entry and manages database as directed and performs other administrative duties related to the Healthcare Benefits Branch of the WTC Health Program as assigned.

Qualification

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NursingResearch ExperienceRegulatory ComplianceProject ManagementEvidence-Based ResearchData AnalysisDatabase ManagementScientific WritingMS WordMS PowerPointMS ExcelSharePointLeanSix SigmaPDSA

Required

Qualified candidates must have successfully completed a bachelor’s degree in nursing.

No New Graduates.

Have and maintain an active nurse license in the US states or territories.

A minimum of five years’ experience in the health care, clinical trials and policy.

A minimum of five years’ experience in project management field.

5-10+ years in nursing, research experience, preferably in an academic or medical setting.

Demonstrates project management experience.

Experience in coordinating and providing support to large complex projects.

Ability to work independently without direct supervision in a fast-paced environment, prioritizing duties and managing time efficiently.

Ability to work both independently with limited supervision as well as in a collaborative team environment.

Preferred

Nurses or nurse practitioners with a master’s or doctoral degree may be preferred.

Knowledgeable in writing scientific publications, federal policy reports, and conducting in-depth research using web-based scientific libraries and research methods is preferred.

Experience in managed health care, health insurance or federal payor models.

Experience in leading performance improvement processes through use of industry accepted modalities, process improvement tools, and techniques (Lean, Six Sigma, PDSA, etc.) preferred.

Advanced proficiency in MS Word, PowerPoint, Excel, and SharePoint.