Designs, develops, and distributes evidence-based medical documents, including clinical practice guidelines, criteria sets, and technology assessments for inclusion into the "Guide for Evidence-Based Medicine.
Researches topics utilizing medical texts and on-line medical literature.
Presents draft document at the Health Net, Inc Medical Director Forum and the Health Net of California Medical Policy Committee.
Investigates and responds to inquiries on medical topics requested by various groups; collects, trends and maintains outside independent review decisions regarding technology assessment and experimental/investigational services.
Works closely with other departments to ensure dissemination of reliable and accurate medical information to physicians and members.
Performs annual reviews of all medical policy documents.
BSN, MSN or equivalent; Desire Masters in epidemiology or equivalent degree in public health or health administration
Must have and maintain current, valid and unrestricted CA RN license;
Three years experience in the managed health care industry
Minimum three years experience in an acute care setting
Knowledge, Skills & Abilities:
Demonstrated outstanding technical and business writing skills with the ability to apply the principles of grammar, punctuation, composition and editing; working knowledge of health care insurance industry standards, including appeals and grievances care management, UM/QM; knowledge of HEDIS,HCFA, NCQA
Intermediate to advanced skills in MS Office, FrameMaker, Adobe Acrobat, Internet access and search
Demonstrated skills in applying tools of evidence-based medicine
Demonstrated knowledge of the principles of clinical research with the ability to interpret and communicate significant research findings consistent with the fundamentals of evidence-based medicine
Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government-sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care ...and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.