Note: The job is a remote job and is open to candidates in USA. Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance with a focus on quality service and ethics. The Clinical Policy Coordinator provides administrative, operational, research, and coordination support for the Medical Technology Assessment Committee and clinical policy governance, including evidence gathering, documentation, meeting management, code evaluation, and implementation of clinical review criteria and prior authorization guidelines.
Responsibilities
- Coordinate MTAC meeting logistics, including calendar management, agenda development support, material preparation, and distribution of meeting documents
- Assist in identifying, organizing, and researching topics for committee review in collaboration with internal stakeholders
- Gather, collate, summarize, and distribute supporting materials for committee consideration, including electronic literature searches, technology assessments, regulatory references, and publications from professional associations, government agencies, and specialty societies
- Support the collection and organization of input from physicians, clinical subject matter experts, and other stakeholders, as needed
- Draft meeting minutes, maintain decision logs, and prepare related committee documentation for stakeholders and leadership
- Assist with drafting and updating clinical review criteria, prior authorization guidelines, code lists, and other supporting materials based on committee direction
- Coordinate follow-up actions resulting from committee decisions and support communication of approved changes to internal departments and delegated vendors
- Maintain organized records of committee materials, supporting evidence, decisions, and implementation documentation
- Support development and maintenance of policies, procedures, workflows, and templates related to MTAC operations
- Assist with implementation activities associated with new or revised guidelines and criteria in coordination with internal teams and external partners
- Review newly released and updated CPT/HCPCS codes to assess applicability to existing benefit structures, utilization management processes, and payment guidelines
- Conduct clinical and regulatory research to support evaluation of new procedures/services, including:
- Peer-reviewed literature
- Specialty society guidelines
- CMS/AMA publications
- Internal claims/utilization trends
- Ensure approved coding determinations are operationalized, including:
- Mapping CPT codes to benefit configurations
- Aligning codes with prior authorization rules and clinical edits
- Supporting configuration in claims/adjudication systems
- Provide clinical support and interpretation to internal teams coding, policy, and benefit questions
- Perform other duties as assigned
Skills
- An active registered nurse (RN) licensure
- Minimum of 2+ years of experience in healthcare administration, health insurance operations, utilization management, medical policy, or a related field
- Familiarity with prior authorization processes, medical necessity criteria, and/or clinical guideline tools
- Experience supporting committees, governance groups, or cross-functional meetings
- Exposure to healthcare regulatory, compliance, or audit documentation processes
- Familiarity with clinical criteria resources such as MCG, InterQual, LOCUS/CALOCUS, or ASAM
- Strong documentation, presentation and project coordination skills
- Outstanding organizational, detail oriented and time management skills, including thorough completion of all time sensitive items
- Strong written and verbal communication skills
- Ability to gather, synthesize, and present information from multiple sources in a clear and organized manner
- Ability to adapt in a developing or evolving governance environment
- Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook
- Self-motivated with the ability to work independently and as a member of the team with minimal supervisory direction
- Manage multiple priorities, simultaneously in a fast-paced environment
- Ability to work effectively with cross-functional teams and stakeholders and manage multiple priorities simultaneously
Benefits
- Life insurance
- Health insurance
- Dental insurance
- Vision insurance
- 401K retirement plan
- Short- and long-term disability coverage
- Flexible/dependent care spending account
- Tuition reimbursement
- Business casual dress
- Life and accident insurance
- 401(k)
Company Overview