Medical Policy Manager jobs in the United States

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Maintain current knowledge of national clinical practice standards and standards of practice from all regulatory agencies including the Magnet Recognition Program®, Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), etc. Collaborate regularly with Quality and Safety Department to ensure that policies and guidelines address TJC standards.
2. Work collaboratively with clinical and non-clinical support departments and hospital leadership to close identified gaps, create standard work, and improve systems and processes related to policy documents.
3. Facilitate and coordinate Policy Oversight Committee.
4. Engage with MEC and system-level leadership to identify appropriate representation of UM SJMC at system-level committees
5. Lead all work surrounding policy management, development, approval, and UMMS Tier 1 and Tier 2 policy changes that directly impact UM SJMC.
6. Performs other duties as assigned

When you come to the University of Maryland St. Joseph Medical Center, you’re coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. You’re embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes convenience and flexibility a priority. Joining our team of healthcare professionals means you’ll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade ‘A’ hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland. In addition, we’ve been consistently recognized as a top employer by Baltimore magazine. 

Education and Experience
1. Five years of experience in nursing required.
2. Bachelor of Science in Nursing required.
3. Licensure as a Registered Nurse in the State of Maryland, or eligible to practice due to Compact State agreements outlined through the Maryland Board of Nursing, is required.
4. Minimum of three (3) years of experience in a leadership role (Senior Clinical Nurse and/or Management)
III. Knowledge, Skills and Abilities
1. Clinical and professional knowledge regarding current issues affecting healthcare delivery, quality management and professional practice is required. Knowledge regarding group dynamics, organizational change and methodologies for affecting change through leadership are required.
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2. Ability to independently develop and manage organizational level projects. Ability to plan, organize and follow through on projects.
3. Demonstrated success in a leadership role exhibiting teaching, coaching and development skills.
4. Demonstrated effectiveness in a consultative role at the organizational level.
5. Knowledge of database management and data analysis is required. Experience with Smartsheet strongly preferred.
6. Demonstrated use of a statistical software package is preferred
IV. Patient Safety
Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
1. Takes action to correct observed risks to patient safety.
2. Reports adverse events and near misses to appropriate management authority.
3. Implements policies, procedure, and standards consistently in the performance of assigned duties.
4. Develops effective working relationships and maintains good communication with other team members.
5. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

Physical Requirements and Physical Demands
*Adequate hearing to perform job duties in person and over the telephone. Hears alarms/telephone/tape
recorder/normal speaking voice.
*Must be able to accurately document pertinent information either by writing or typing.
*Must be able to communicate clearly in person and over the telephone.
Balancing: Occasionally within shift (1-33%)
Bending: Occasionally within shift (1-33%)
Climbing: Occasionally within shift (1-33%)
Crawling: Occasionally within shift (1-33%)
Crouching: Occasionally within shift (1-33%)
Kneeling: Occasionally within shift (1-33%)
Lift above shoulders/head: Occasionally within shift (1-33%)

Lift from floor level up: Occasionally within shift (1-33%)
Lift from waist level up: Occasionally within shift (1-33%)
Lifting 10 lbs. maximum and occasionally lifting and/or carrying articles: Occasionally within shift (1-33%)
Lifting 20 lbs. maximum and frequent lifting and/or carrying of objects weighing up to 10 lbs: Occasionally
within shift (1-33%)
Pulling with force: Occasionally within shift (1-33%)
Reaching above head: Occasionally within shift (1-33%)
Reaching above shoulder: Occasionally within shift (1-33%)
Sitting: Frequently within shift (34-66%)
Squatting: Occasionally within shift (1-33%)
Standing: Occasionally within shift (1-33%)
Walking: Frequently within shift (34-66%)
Working Environment
May be exposed to dust/particulate matter.