Sr Clinical Policy Analyst

Duties/Responsibilities: * Support the Medical Policy and Clinical Utilization Management (UM) Governance Committee Chairs, committee members, and related workgroups by organizing all meeting materials (e.g. meeting minutes, presentations, etc.), tracking follow-up activities, and preparing/maintaining related reports and documentation. * Facilitate the Healthfirst medical and clinical policy processes, including developing new policies, monitoring industry policy trends and tracking annual policy renewals/approvals. * Collaborate on policy reviews with committee stakeholders and clinical business unit stakeholders * Engage with, support and spearhead the policy work that will inform Medical and Clinical strategy * Perform editorial formatting and review of policies, confirm policy references, and obtain necessary approvals from key governance committee members. * Review the appropriate UM or related clinical and medical policies, job aids/procedures, and correspondence and make recommendations for policy creation/revision and/or committee action * Ensure parity in processes across clinical and medical departments * Conduct ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. * Collaborate with the Regulatory, Compliance, Legal and Clinical departments to ensure deliverables adhere to local, state, federal, and Healthfirst-specific compliance and regulatory guidelines. * Monitor any Corrective Action Plans (CAPs) and related committee/workgroup activities through to completion * Identify potential organizational risks and help facilitate process improvements * Support accreditation submissions, regulatory surveys, and internal audits * Ensure timely and accurate responses to any requests for information or audits. * Build sustainable relationships of trust through open and interactive communication with cross-functional teams at all levels within Healthfirst. * Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information. * Additional duties as assigned Minimum Qualifications: * Associate’s degree from an accredited institution * Registered Nurse (RN), Licensed Social Worker (LCSW or LMSW) * Work experience using and interpreting medical terminology and concepts * Knowledge of Centers for Medicare and Medicaid Services (CMS) and/or New York State Department of Health (NYSDOH) regulations * Previous regulatory/compliance experience within a managed care environment * Experience with Clinical guidelines including but not limited to Milliman Care Guidelines, Hayes Clinical Guidelines, Encoder Pro, EMEDNY,CMS National and Local Coverage Determinations Preferred Qualifications: * Bachelor’s degree * Knowledge of compliance and regulatory guidance/regulations across the Medicaid, Medicare, MLTCPs, and Commercial Lines of Business. * Experience working in a fast-paced environment that requires flexibility and adapting to change while managing multiple priorities simultaneously. * Work experience requiring strong verbal and effective written communications while demonstrating exceptional grammar and spelling skills. * Experience presenting and communicating to cross-functional groups within an organization * Problem-solving, initiative taking, multitasking and critical thinking skills * Experience with MS Office Suite, MS Teams, MS Outlook, SharePoint, Logic Manager, and Adobe Acrobat.

Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 * All Other Locations (within approved locations): $71,600 - $106,505 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.