Med Policy Coordinator RN

Responsible for research, analysis, evaluation, development and maintenance of BCBSM/BCN medical policies in collaboration with medical directors and corporate committees. This includes oversight and coordination of all activities related to the development and maintenance of medical policies in accordance with current peer-reviewed literature, certificates, riders, federal and state mandates, CMS guidelines, BCBSM/BCN policies and procedures. Responsibilities include investigation of new procedures, technologies, devices, healthcare services and maintenance of clinical documentation, treatment modalities as well as communication and education to internal and external stakeholders including team members, leadership and other areas throughout the corporation Identify and evaluate new treatment and technology for potential coverage by BCBSM/BCN. Develop policies for presentation to various committees, including Joint Uniform Medical Policy (JUMP) and Medical Affairs Policy Review Committee (MAPRC). Develop and maintain a resource base (FDA, BCBSA, CMS, Hayes, etc.) for additional technology and current literature review to support medical policy decisions. Research, analyze and compile supporting documentation of evidence-based literature sourced from national medical professional organizations, peer-reviewed medical literature, specialty associations, society publications and guidelines for medical policy determinations for new policy development and annual review of active medical policies. Coordinate all aspects of policy development and maintenance of assigned medical policies in collaboration with internal team and assigned medical policy directors. The medical policy coordinator is expected to be a medical policy subject matter expert that can advise and partner with the team throughout the medical policy process. Provide clinical knowledge and medical policy expertise for medical policy development and maintenance, inquiries, projects, initiatives, and work groups as related to medical policy interpretation and coding (ICD-10, CPT, HCPCS) of services identified on policies. Respond to moderate and complex medical policy inquiries to ensure appropriate medical policy interpretation and utilization of policy criteria. Active participation in consultations with internal teams and external practitioners, providers, medical groups and professional associations, as necessary, to obtain advice and expertise in development and maintenance of medical policies. Other duties as assigned by leadership. Department Preferences: Excellent research skills which include the ability to analyze peer-reviewed medical literature for statistical significance. Excellent written communication skills including grammar, spelling, punctuation and standardized formatting to produce professional medical policies published for both internal and external stakeholders. Excellent oral communication skills with the ability to present assigned medical policies including supporting rationale to large committees.

Created: 2026-01-22