Correspondence Policy Manager

Missouri, United States Minor Outlying Islands

Job Description

Responsible for the development, approval, and maintenance of corporate clinical correspondence to ensure compliance with legislative and accreditation requirements. Responsible for the development and annual review of Centers for Medicare and Medicaid Services (CMS) clinical policies. Act as the clinical liaison to the Compliance Department.
  • Develops and customizes correspondence according to regulatory requirements and contractual requirements including coordinating Compliance Department approval for new and existing business.   
  • Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates. 
  • Clinical liaison to Compliance Department.  
  • Oversees clinical correspondence for all products in collaboration with compliance.  
  • Reviews correspondence and clinical policy submissions under our UR licensure submissions.  
  • Updates clinical correspondence templates as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segments. 
  • Develops and maintains Centers for Medicare and Medicaid Services  (CMS) clinical policies. Develop new policies for new or existing business, as assigned.
  • Researches state regulatory requirements for clinical correspondence and policies using online technology and research tools.
  • Develops and implements best practices related to the timely and consistent generation of clinical correspondence.
  • Consults with IT to support the letter generation process
  • Supervision and evaluation of staff.
  • Special projects as assigned.

General Job Information

Title

Correspondence Policy Manager

Grade

22

Job Family

General Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/27/2019

Date Requisition Created

3/27/2019

Minimum Qualifications

Education

Bachelors

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5+ years of healthcare industry experience.
  • 3+ years of experience with authorization correspondence, ensuring compliance with state/federal contractual requirements.
  • Strong interpersonal, consultation, organizational, tracking and follow-up skills.
  • Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
  • Possesses excellent verbal and written communication skills.
  • Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS)].
  • This position requires a solid understanding of Magellan's products and workflows in relation to policies and standards.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.