Medical Policy Analyst

The Medical Policy Team resides within the Office of Healthcare Policy and Authorization (OHPA) and is a dynamic and collaborative team dedicated to shaping evidence-based healthcare coverage policies. OHPA lies within the Division of Integrated Healthcare (DIH) that plays a pivotal role in delivering essential healthcare services to eligible Utah residents. We oversee critical programs and focus on
developing and implementing policies that ensure comprehensive coverage, support a robust provider network, and foster coordination across the healthcare continuum. Through rigorous policy development, data-driven analysis, and collaborative partnerships, we strive to build a healthier Utah. Our work ensures that Medicaid members receive high-quality, appropriate care while adhering to
complex regulatory frameworks. We foster an environment of continuous learning, mutual support,
and accountability.

We are seeking an experienced and highly motivated Medical Policy Analyst to join our team. This is a critical role that will drive the day-to-day development, analysis, and implementation of medical policies. This position offers a unique opportunity to directly impact healthcare quality and access within a supportive and forward-thinking environment.

Key Responsibilities:
The Medical Policy Analyst will focus on the execution and technical oversight of our policy functions,
including:

Policy research and analysis:

• Perform comprehensive literature reviews, including clinical guidelines, scientific publications, and industry reports.

• Direct the collection, interpretation, and analysis of diverse data (e.g., clinical outcomes, utilization, cost, epidemiological data).

Coverage policy development and content:

• Lead the development, evaluation, and updating of medical necessity criteria and clinical coverage policies for services, procedures, and devices.

• Ensure the integration of evidence-based clinical guidelines from authoritative sources into coverage policies.

Policy implementation and operation coordinator:

• Develop and maintain standard operating procedures (SOPs) and desk aids for policy application and operational workflows.

• Provide policy guidance for operational offices.

• Oversee routine policy monitoring activities to ensure effectiveness and adherence.

Communication and stateholder engagement:

• Lead the drafting of clear and concise policy documents, reports, summary documents, and presentations.

• Coordinate day-to-day stakeholder engagement efforts, gathering input and communicating policy details.

Project management and quality assurance:

• Manage individual projects within the Medical Policy Team, ensuring timely and high-quality deliverables.

• Perform rigorous quality assurance reviews of policy documents, research outputs, and system implementation plans.
  
  

• Possession of a nursing degree and a current, unrestricted license as a: 
  1. Registered Nurse (RN), or 
  2. Advanced Practice Registered Nurse (APRN)
• Minimum of 5 years’ experience as a 
  1. Registered Nurse (RN), or 
  2. Advanced Practice Registered Nurse (APRN)

Skills:  

• Exceptional research, analytical, and critical thinking abilities.
• Superior written and verbal communication skills, with the ability to distill complex information into clear, actionable insights.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and deadlines effectively.
• Demonstrated ability to work collaboratively in a team environment

Why work for the Utah Department of Health and Human Services?  In addition to the rich benefits  the State of Utah offers, the department offers:

• On-site fitness center, for a minimal membership fee
• UTA Eco Pass, at a discounted monthly rate
• Teleworking opportunities with a minimum 2 office days per week beginning 04/2024.
• On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, 385-382-4012 or firststepschildcareslc@gmail.com

For more information on the Utah Department of Health and Human Services, please click here.

If offered this position, your employment will be contingent upon passing a background check and review.  There will be no cost to you for this check.  This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment.  You may review the policy by clicking here.

• Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.
• Please include with your application at least three recent professional references (within the last five years).

• Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to Utah within 30 days of their start date.

• This position may currently be a hybrid of both in-office and remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time, and for any reason