Medical Policy Specialist jobs in Hawaii
Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Medical Policy Specialist jobs
Information Technology Specialist (Policy and Planning).
- U.S. Army Cyber Command
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Honolulu, HI
FULL_TIME
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Duties
- Project Management: Plans, justifies, and manages (to include planning, tasking, requirements, operations, and training) multiple concurrent programs to meet DoD and Army strategy for the 516th Theater Signal Brigade.
- Develops and analyzes the business and IT requirement, performs business case analysis, risk assessment, manages quality assurance, and monitors successful delivery.
- Presents briefings, updates and mitigation to Leaders and Staff for information and follow-on actions.
- Determines appropriate products or services to define project scope, requirements, and deliverables.
- Responsible for planning, programming, budgeting and executing IT requirements in support of assigned information programs / projects / services.
- Develops issues/input for project and program building, program objective memorandum (POM) submissions; monitors status, and manages program operations and maintenance (OMA) and investment (OPA) funds for assigned areas.
- Provides support and expertise for assigned areas and maintains current knowledge of relevant hardware and software applications.
- Develops and implements Pacific Theater IM/IT plans. Provides direction and guidance related to IM/IT governance to assure consistency with the overall DoD directives, policies and plans.
Conditions of Employment- Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.
- Three year trial/probationary period may be required.
- Must obtain and maintain SEC within 6 months of employment.
- Must obtain/maintain certification at Level 2 in Information Assurance Management (IAM-11) within 6 months or less of entrance to duty. Certification requirements may be found in DoD 8570 Information Assurance Workforce Improvement Program.
- This position requires the incumbent be able to obtain and maintain a determination of eligibility for a Secret security clearance or access for the duration of employment.
- See "Additional Information" section for additional requirements.
This position is in the Professional Work Category at the Full Performance Work Level within the CES Occupational Structure.
Who May Apply
Only applicants who meet one of the employment authority categories below are eligible to apply for this job. You will be asked to identify which category or categories you meet, and to provide documents which prove you meet the category or categories you selected. See- Current Army Cyber Excepted Service (CES) Employee
- Current Army Defense Civilian Intelligence Personnel System (DCIPS) Employee
- Current Civilian Employees of the Organization Applying to Cyber Excepted Service (CES) Positions
- Current Department of Army Civilian Employees
- Current DoD Cyber Excepted Service (CES) Employee (non-Army)
- Current Permanent DoD Civilian Employee (non-Army) Applying to Cyber Excepted Service Positions
- Non-Department of Defense (DoD) Transfer Applying to Cyber Excepted Service Positions
In order to qualify, you must meet the education and/or experience requirements described below. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is
Skills
To qualify based on your experience, your resume must describe one year specialized experience that demonstrates the possession of knowledge, skills, abilities, and competencies necessary for immediate success in the position. Such experience is typically in or directly related to the work of the position to be filled. Specialized experience would be demonstrated by:
Knowledge of Microsoft project, and a current Project Management Professional (PMP) or the ability to complete this certification within 1 year of hire is optimum. Good communication skills will facilitate tasks with stakeholders and customers. Solid basis in Information Technology skills (Automation, Networks, Cyber Security, Infrastructure, systems ect). Previous Army or government Project management at 5 years is required for the complex projects being managed.
Basic Requirement For Information Technology Specialist (Policy And Planning)
Specialized and Other Experience: One year of specialized experience which includes knowledge of Microsoft projects; good communication skills; ability to facilitate tasks with stakeholders and customers; knowledge in Information Technology skills (Automation, Networks, Cyber Security, Infrastructure, systems); experience working with complex projects. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GG-11).
The Specialized Experience Must Include, Or Be Supplemented By, Information Technology Related Experience (paid Or Unpaid Experience And/or Completion Of Specific, Intensive Training, As Appropriate) Which Demonstrates Each Of The Four Competencies, As Defined- Attention to Detail - Is thorough when performing work and conscientious about attending to detail. Examples of IT-related experience demonstrating this competency include: completing thorough and accurate work independently, even in the most difficult or stressful situations; occasionally reviewing work completed by others.
- Customer Service - Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services. Examples of IT-related experience demonstrating this competency include: resolving routine and non-routine problems, questions, or complaints; developing and maintaining strong, mutually supportive working relationships with customers; conducting evaluation of support to determine quality of services and customer satisfaction, and recommending procedural changes based on customer need or changes in policy and/or regulation.
- Oral Communication - Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately. Examples of IT-related experience demonstrating this competency include: convincingly conveying complex information to customers; presenting thoughts that are well-organized and demonstrating confidence in the facts and ideas; adjusting style when working with individuals with different levels of understanding; using various methods to explain and convey information.
- Problem Solving - Identifies problems; determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations. Examples of IT-related experience demonstrating this competency include: solving complex or sensitive problems by developing and proposing strategic alternatives; identifying possible conflicts and shared benefits; helping team anticipate problems and identifying and evaluating potential sources of information; providing feedback and coaching to others to help solve problems; engaging appropriate stakeholders when developing solutions in order to understand and incorporate multiple perspectives and needs; evaluating the effectiveness of decisions and adjusting future decisions as appropriate.
Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.
Additional information- If you are a current federal career/career-conditional employee, you will be placed on an excepted appointment.
- Male applicants born after December 31, 1959, must complete a Pre-Employment Certification Statement for Selective Service Registration.
- You will be required to provide proof of U.S. Citizenship.
- Direct Deposit of Pay is required.
- Selection is subject to restrictions resulting from Department of Defense referral system for displaced employees.
- If you have retired from federal service and you are interested in employment as a reemployed annuitant, see the information in the
- This is a(CP) 34 - Information Technology Management Career Field position.
- Multiple positions may be filled from this announcement.
- Salary includes applicable locality pay or Local Market Supplement.
- When you perform a Civilian Permanent Change of Station (PCS) with the government, the Internal Revenue Service (IRS) considers the majority of your entitlements to be taxable. Visit https://www.dfas.mil/civilianemployees/civrelo/Civilian-Moving-Expenses-Tax-Deduction/ for more information.
- Permanent Change of Station (PCS) allowances may be authorized, subject to the provisions of the Joint Travel Regulations and an agency determination that a PCS move is in the Government Interest.
- This position must complete Project Management Professional (PMP) training within 6 months. PMP Certification requires 5 years professional project management experience before the exam can be taken and certification received. Certification must be completed within 6 months after meeting the 5-year experience requirement.
- A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.
- 5 Days Ago
Medical Management Policy and Research Analyst II
- HMSA
-
Honolulu, HI
FULL_TIME
- Revise and/or develop medical policies in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropria...
- 1 Month Ago
IT Cybersecurity Specialist (Information Security/Policy Plan)
- US Defense POW/MIA Accounting Agency
-
Hickam AFB, HI
FULL_TIME
- Duties This is a Direct Hire Public Notice, under this recruitment, applications will be accepted for each location and/or installation identified in this Public Notice and selections are made for vac...
- 2 Months Ago
Associate Spine Specialist
- Globus Medical
-
Hawaii County, HI
FULL_TIME
- About UsAt Globus Medical, we move with a sense of urgency to deliver innovations that improve the quality of life of patients with musculoskeletal disorders. Our team is inspired by the needs of thes...
- 8 Days Ago
Medical Billing Specialist
- Navian Hawaii, formerly Hospice Hawaii
-
Honolulu, HI
FULL_TIME
- Position SummaryThe Medical Billing Specialist under the supervision of the Accounting Manager (AM) will process billing and payment in Account Receivables. They will maintain a schedule, ensuring pay...
- 4 Days Ago
Medical Billing Specialist
- Navian Hawaii
-
Honolulu, HI
FULL_TIME
- POSITION SUMMARY: The Medical Billing Specialist under the supervision of the Accounting Manager (AM) will process billing and payment in Account Receivables. They will maintain a schedule, ensuring p...
- 8 Days Ago
Medical Policy Specialist jobs at Popular Companies
(Physician) Medical Specialist 2
- Office for People with Developmental Disabilities
-
Thiells, NY
- Job Description Job Description EMPLOYMENT OPPORTUNITY ANNOUNCEMENT EOA #: 23-061RR EOA DATE: March 15, 2024 REPLY BY: S...
- 6/11/2024 12:00:00 AM
Medical Specialist
- U.S. Air Force Reserve
-
- Position Summary Our hundreds of medical facilities around the world are only as good as the staff who run them. Providi...
- 6/10/2024 12:00:00 AM
Bio Medical Specialist
- United Health Services
-
Johnson City, NY
- Bio Medical Specialist, UHS Wilson Medical Center United Health Services is seeking a Bio Medical Specialist to join our...
- 6/10/2024 12:00:00 AM
Medical Specialist 2
- State of New York
-
Tupper Lake, NY
- Please note: State agencies that contact job applicants do not usually request personal or financial information via tex...
- 6/9/2024 12:00:00 AM
Medical Specialist 1
- State of New York
-
Tupper Lake, NY
- Please note: State agencies that contact job applicants do not usually request personal or financial information via tex...
- 6/9/2024 12:00:00 AM
Medical Specialist 2
- State of New York
-
Thiells, NY
- Please note: State agencies that contact job applicants do not usually request personal or financial information via tex...
- 6/9/2024 12:00:00 AM
Medical Assistant/ Medication Specialist
- Nidraveda PA
-
San Antonio, TX
- Job Description Job Description We are looking for someone with a professional attitude, a dedication to healthcare, and...
- 6/9/2024 12:00:00 AM
Certified Medication Specialist
- Mosaic
-
Beatrice, NE
- Schedule: Full-Time Days, Evenings, Overnights Part-Time Evenings If making a positive impact in the lives of others is ...
- 6/8/2024 12:00:00 AM
About Hawaii
Hawaii (/həˈwaɪi/ (listen) hə-WY-ee; Hawaiian: Hawaiʻi [həˈvɐjʔi]) is the 50th and most recent state to have joined the United States, having received statehood on August 21, 1959. Hawaii is the only U.S. state located in Oceania, the only U.S. state located outside North America, and the only one composed entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean.
The state encompasses nearly the entire volcanic Hawaiian archipelago, which comprises hundreds of islands spread over 1,500 miles (2,400 km). At the southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$93,906 to $114,620
Most Popular Cities in Hawaii for Medical Policy Specialist Jobs
What does a Medical Policy Specialist do?
Medical Policy Specialist in Norfolk, VA
Guideline 9 – specialist medical procedures provides that applications for the separate representation of children with an intellectual impairment in relation to applications for special medical procedures are not subject to the means test or merits test.
February 20, 2020