Medical/Clinical Policy Writer

CareSource

. Research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies .

Posted 10/22/2026full-timeUnited StatesJuniorMid-Level💰 $72,200 - $115,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical policy development and implementation, with strong analytical skills to interpret complex healthcare literature. Proficient in collaborating with interdisciplinary teams and ensuring compliance with healthcare regulations and guidelines.

Highest-signal resume keywords

Medical Policy DevelopmentHealthcare Writing ExperienceAnalytical SkillsClinical ExpertiseRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical TerminologyPolicy ImplementationHealthcare AdministrationComplex Information InterpretationBibliographic Software Proficiency

Soft Skills

Presentation SkillsVerbal CommunicationWritten CommunicationOrganization SkillsProblem-Solving Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelSearch Engines

Certifications & Qualifications

RN Licensure

Industry Keywords

Healthcare PolicyManaged CareNCQA RequirementsMedicareMedicaid

About the role

Key responsibilities & impact

Research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies
Ensure adherence to company, state, and federal guidelines
Support the operational processes of the Policy Governance Committee
Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies
Support internal departments and processes in the development and implementation of policies and procedures
Ensure medical policies comply with relevant regulations and remain consistent across all lines of business
Participate in department initiatives and projects
Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform CPC
Create and update policy bibliographies
Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities
Provide policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products, and other markets as business needs change
Coordinate with subject matter experts to develop policies affecting CareSource from medical/clinical, BH, and reimbursement perspectives
Monitor legislative and regulatory activities for potential impact on existing or proposed policies
Collaborate with interdisciplinary team members to achieve team goals
Perform other job duties as requested

Requirements

What you’ll need

Bachelor’s degree or equivalent years of relevant work experience is required
Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred
Minimum of two (2) years of experience in medical policy development and/or implementation preferred
Strong presentation skills
Computer skills/proficiency with Microsoft Word, Excel, search engines, and bibliographic software
Knowledge of medical terminology and claims payment policies
Strong clinical expertise and healthcare administration understanding
Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature
Ability to interpret complex clinical information and apply it to policy development
Excellent verbal and written communication skills
Presentation and decision-making skills
Excellent organization and tracking skills
Good problem-solving skills
Ability to interface with employees at all levels
Ability to handle multiple priorities/projects simultaneously
RN or equivalent clinical licensure preferred, or in lieu of licensure: 2 years Clinical/Medical policy writing experience or equivalent Policy/Healthcare experience
Knowledge of NCQA policy timely requirements

Benefits

Comp & perks

Work from home / virtual office opportunity
Occasional travel to main office
Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Total well-being support
Equal opportunity and belonging-focused workplace