Clinical Policy Development Analyst

Avalon Healthcare Solutions

. Research emerging laboratory tests, technologies, clinical guidelines, coding changes, payer policies, and utilization trends .

Posted 10/8/2026full-timeRemote • Florida • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating clinical literature and translating evidence into clear policy language, with a strong focus on developing clinical policies for healthcare organizations. Proficient in managing multiple policy-development projects while collaborating effectively across clinical, product, technical, and operational teams.

Highest-signal resume keywords

Clinical Policy DevelopmentResearch and Analytical SkillsDiagnostic Testing KnowledgeCMS NCDs and LCDs FamiliarityAI-Assisted Research Tools Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Literature EvaluationPolicy DraftingMedical Necessity CriteriaCoverage RequirementsClaims Data AnalysisDocumentation SkillsPolicy ImplementationEvidence SynthesisUtilization Trends AnalysisPolicy Gap Review

Soft Skills

Strong Writing SkillsProject ManagementCollaborationEffective CommunicationOrganizational Skills

Tools & Technologies

AI ToolsLarge Language ModelsResearch DatabasesVersion-Controlled Documentation

Certifications & Qualifications

Advanced Clinical or Scientific DegreeRelevant Professional Credential

Industry Keywords

Healthcare PolicyLaboratory TestingPathologyHealth Plan Coverage PoliciesUtilization ManagementProfessional Society GuidelinesPayer Policies

About the role

Key responsibilities & impact

Research emerging laboratory tests, technologies, clinical guidelines, coding changes, payer policies, and utilization trends
Identify and prioritize opportunities for new routine testing policies based on clinical evidence, market need, claims data, and potential client value
Review and summarize peer-reviewed literature, professional society guidance, CMS coverage requirements, and other authoritative sources
Draft clinical policies defining scope, medical necessity criteria, coverage requirements, exclusions, limitations, and supporting references
Present policy recommendations for clinical review and revise draft policies through approval and publication
Review the existing policy library for coverage gaps, outdated references, or opportunities to expand or consolidate policies
Maintain organized research, citations, decision records, and version-controlled policy documentation
Partner with Product, Scientific Affairs, Coding & Translation, and claims-editing teams to support policy implementation and answer questions about policy intent
Use approved AI and large language model tools to support research, policy comparison, and evidence synthesis while validating outputs against authoritative sources

Requirements

What you’ll need

Demonstrated ability to evaluate clinical literature and translate evidence into clear policy language
Familiarity with diagnostic testing, medical necessity, and health plan coverage policies
Strong research, analytical, writing, and documentation skills
Ability to manage multiple policy-development projects and work effectively across clinical, product, technical, and operational teams
Advanced clinical or scientific degree or relevant professional credential (preferred)
Experience developing clinical policies for a health plan, laboratory benefit manager, utilization management organization, or healthcare technology company (preferred)
Knowledge of routine laboratory testing, pathology, and diagnostic coding (preferred)
Familiarity with CMS NCDs and LCDs, commercial payer policies, and professional society guidelines (preferred)
Experience using claims data or AI-assisted research tools to identify and evaluate policy opportunities (preferred)

Benefits

Comp & perks

Eligible for remote work
Quarterly travel required to Avalon’s corporate office in Tampa, Florida