BCBSNE
Medical Policy & Special Project Clinical Analyst - RN
Work at Home - Nebraska
Sponsorship not specifiedDetected 14 days ago
Project ManagementICD-10Public HealthLeadershipCommunicationCollaborationProblem SolvingPublic SpeakingClaims Management
About the role
- Our team is the power behind that promise.
- The Medical Policy & Special Projects Clinical Analyst serves as the organization's senior clinical subject matter expert for medical policy development, clinical coding strategy, and complex claims configuration initiatives.
- This role provides strategic leadership in translating evolving clinical practice, regulatory guidance, coding updates, and evidence-based medicine into operational medical policies and claims processing solutions.
Responsibilities
- Lead evaluation and implementation of ICD-10, CPT, HCPCS, NCCI, CMS, and other industry coding updates impacting claims adjudication.
- Partner with Configuration and IT teams to translate clinical requirements into system functionality.
- Provide expert consultation to executive leadership and business partners regarding complex clinical policy issues.
- Build collaborative partnerships across internal departments and external vendors.
- Lead workgroups and facilitate consensus among stakeholders on complex clinical and operational issues.
- And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!
- Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
- Demonstrated ability to lead complex cross-functional initiatives and influence decision-making without direct authority.
Requirements
- To Be Considered for This Position, You Must Have
Benefits
- At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
- Medical necessity criteria and evidence-based clinical practice
- Experience supporting or implementing claims systems, configuration, or healthcare technology solutions.
- Experience with HealthRules or other healthcare claims processing platforms.
- Experience within a health insurance organization or managed care environment.
- Knowledge of regulatory requirements including CMS, NCQA, URAC, and applicable federal and state healthcare regulations.
This listing is sourced directly from BCBSNE's careers page and normalized into a canonical job model.