Medical Policy Specialist jobs in New Mexico

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)

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Statewide Policy Manager
  • Center for Civic Policy
  • Albuquerque, NM FULL_TIME
  • Job Title: Policy Director

     

    Reports to: Chief Executive Officer 

     

    Job Purpose: [Using independent judgment and discretion], Contributes to the overall success of CCP by taking a leadership role in policy research and development, communicating the findings, proposing strategic policy campaigns, and effectively advocating and effectively communicating with team members, policy-makers, and allied organizations.


    Primary Duties and Responsibilities

    • Independently leads the strategic assessment of potential strategic initiative campaigns and CCP policy opportunities, and makes recommendations regarding CCP’s engagement in those policies. 
    • Independently leads the planning and evaluation of CCP/NM C3 Table strategic initiative and policy campaigns. 
    • Independently leads research and development of model policy and legislation based on CCP priorities and allies’ requests. 
    • Independently leads education on specific policies for CCP staff and allies.
    • Independently leads CCP advocacy initiatives before state governmental bodies.


    Secondary Duties and Responsibilities

    • Maintains a working knowledge of local, state, and national political/public policy news.  
    • Supports Chief Operating Officer in completing administration tasks.  
    • Supports Chief Executive Officer and Chief Operating Officer in training allies to manage and implement campaign plans. 
    • Supports Chief Executive Officer in communicating CCP’s work to current and potential funders, as requested.

     

    Qualifications

    Knowledge, Skills and Abilities

     

    •  Research: Intermediate experience with research design both quantitative and qualitative research.  Uses independent judgment and discretion to effectively communicate that research to internal and external teams and allies.


    • Remains Informed: Understands local, state and national political and public policy landscape.  


    • Behaves Ethically: Understands ethical behavior and business practices and ensures own behavior and the behavior of others is consistent with these standards and aligns with the values of the organization.

     

    • Builds Relationships: Establishes and maintains positive working relationships with others both internally and externally to achieve the goals of the organization.

     

    • Communicates Effectively: Speaks, listens and writes in a clear, thorough and timely manner using appropriate and effective communication tools and techniques.

     

    • Focuses on Allies Needs: Anticipates, understands, and responds to the needs of internal and external allies to meet or exceed their expectations within the organizational parameters.

     

    • Fosters Teamwork: Works cooperatively and effectively with others to set goals, resolve problems and make decisions that enhance organizational effectiveness.

     

    • Leads: Positively influences others to achieve results that are in the best interest of the organization.

     

    • Makes Decisions: Assesses situations to determine the importance, urgency and risks, and make clear decisions which are timely and in the best interests of the organization

     

    • Organizes: Sets priorities, develops a work schedule, monitors progress towards goals, and tracks details, data, information and activities.

     

    • Plans: Determines strategies to move the organization forward, sets goals, creates and implements actions plans, and evaluates the process and results.

     

    • Solves Problems: Assesses problem situations to identify causes, gather and process relevant information, generates possible solutions, and makes recommendations and/or resolves the problem.

     

    • Technology: Maintains proficiency in MS Office applications, Email and Internet.

     

    Education

    • Bachelor’s degree preferred (Minimum of 1-2 years of directly related experience required) and/or 5-6 years directly related experience.
    • Direct experience with issue and or political campaigns.

     

    Salary

    The starting salary range for this position is between $60,000 to $75,000 annually depending on experience.  The final salary will be based on an internal equitable scale that takes into consideration years of experience, educational attainment, management responsibilities, and final job description. We also offer a robust benefits package for full time employees including paid time off; 100% of health, dental, vision; retirement plan; professional development funding; remote work reimbursements and on site childcare for employees with children. CCP prides itself for developing family friendly policies and currently we are at the Platinum level with the NM Family Friendly Business Awards.


    The Center for Civic Policy is an equal opportunity employer and actively works to ensure fair and equal treatment of its employees regardless of differences based on culture, socioeconomic status, race, marital or family situation, gender, age, ethnicity, religious beliefs, physical ability or sexual orientation.

  • 3 Days Ago

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Bilingual Field Data Collector (PPC)
  • Mathematica Policy Research
  • DoñaAna, NM PER_DIEM
  • Position Description:Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public-and private-sec...
  • 1 Month Ago

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Granite Installer
  • Ray's Flooring Specialist, Inc.
  • Albuquerque, NM FULL_TIME
  • Ray’s Flooring Specialists, Inc., a local, family owned company since 1972, is accepting applications for a Regular Full-Time Granite Installer. Ray’s Flooring is looking for an experienced granite in...
  • 29 Days Ago

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Biologist-Environmental Compliance Specialist
  • Environmental Compliance Specialist - Tetra Tech Careers
  • Albuquerque, NM FULL_TIME
  • Are you looking for a chance to build your career with a company who is Leading with Science? Are you interested in working with a group of talented women and men who drive innovation and celebrate th...
  • 2 Months Ago

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Scheduling Specialist
  • UNM Medical Group, Inc.
  • Albuquerque, NM FULL_TIME
  • UNM Medical Group, Inc. is hiring for an Scheduling Specialist to join our Locum Tenens department. This opportunity is a PRN opening located in Albuquerque, New Mexico. Remote Position-Selected candi...
  • 1 Day Ago

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Housekeeping specialist
  • Los Alamos Medical Center
  • Los Alamos, NM FULL_TIME
  • Housekeeping Specialist, PRN-7435-2377Los Alamos Medical Center Description At Los Alamos Medical Center, we work hard to provide high quality care that’s continuously recognized for excellence. In th...
  • 20 Days Ago

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(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

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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

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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

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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

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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

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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

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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

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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

New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$82,853 to $101,129

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