Behavioral Health Medical Policy Analyst

Centene Corporation

. Assist the Chief Medical Director, Medical Management and Utilization Management Operations with technical writing and research related to clinical practices, policies, guidelines, and technology assessments .

Posted 11/4/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in technical writing and research related to clinical practices and policies, with a strong focus on compliance and evidence-based decision-making in healthcare. Proficient in collaborating with cross-functional teams to develop and maintain clinical guidelines and policies.

Highest-signal resume keywords

Technical WritingHealthcare AnalysisClinical Policy DevelopmentEvidence-Based ResearchCompliance Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Technical WritingHealthcare AnalysisClinical Policy DevelopmentEvidence-Based ResearchClaims System Implementation

Soft Skills

CollaborationCommunicationProblem-Solving

Tools & Technologies

Web PortalsProvider Manuals

Certifications & Qualifications

Registered Nurse (RN)

Industry Keywords

Medical TechnologyLife SciencesClinical Coverage GuidelinesClaims Edit GuidelinesFraud Investigation

About the role

Key responsibilities & impact

Assist the Chief Medical Director, Medical Management and Utilization Management Operations with technical writing and research related to clinical practices, policies, guidelines, and technology assessments
Conduct research using evidence-based criteria and authorization rules to support clinical decision making
Assist with technical assessments of new medical technologies and procedures
Help provide full disclosure of medical policies to members and providers through web portals and provider manuals
Conduct research for the Special Investigations Unit to identify fraud, waste, and abuse
Provide research and criteria to support legal proceedings regarding clinical policy
Work with claims, configuration, and claims dispute teams to ensure proper implementation of medical policy in the claims system
Track timelines and update clinical policies to meet compliance, state, federal, and accreditation requirements
Support annual and as-needed updates to Clinical Coverage Guidelines, Claims Edit Guidelines, and Clinical Practice Guidelines
Maintain and track issues concerning medical, pharmacy, and behavioral health policy development and maintenance
Support governing committees, including the Medical Policy Committee and Claims Payment Policy Committee
Participate in cross-functional teams addressing key clinical policy issues
Perform other duties as assigned

Requirements

What you’ll need

A Bachelor's Degree in Medical Technology, Life Sciences or other related field or equivalent experience
3+ years of experience in healthcare, analysis, technical writing, or health administration
Experience in writing technical publications in the healthcare field
Registered Nurse (RN) preferred

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation