Clinical Policy Development Analyst

Clinical Policy Development Analyst (Remote)

About the Opportunity

A growing healthcare technology organization is seeking a Clinical Policy Development Analyst to support the development of evidence-based clinical policies that guide coverage and reimbursement decisions across a large payer network. This role will focus on researching emerging diagnostic testing and healthcare trends, evaluating clinical evidence, and developing clear, actionable policy recommendations.

This is a highly collaborative position that partners with clinical, product, coding, operational, and technical teams to ensure policies are translated into practical implementation strategies.

Responsibilities

• Research emerging diagnostic tests, laboratory services, clinical technologies, and healthcare trends.
• Review and synthesize peer-reviewed literature, professional society guidelines, government coverage guidance, and other authoritative sources.
• Evaluate clinical evidence and identify opportunities for new or enhanced coverage policies.
• Draft, revise, and maintain clinical policies, including medical necessity criteria, coverage requirements, limitations, exclusions, and supporting references.
• Present policy recommendations to clinical reviewers and incorporate feedback throughout the approval process.
• Assess existing policies for accuracy, consistency, relevance, and opportunities for improvement.
• Maintain organized documentation, research summaries, policy histories, and supporting rationale.
• Collaborate with cross-functional stakeholders to ensure approved policies are implemented consistently and aligned with business objectives.
• Utilize approved AI-assisted research and evidence-review tools while validating all findings against authoritative sources.
• Manage multiple policy development projects in a fast-paced environment.

Qualifications

• Experience evaluating clinical literature and translating evidence into clear, actionable policy language.
• Understanding of medical necessity criteria, healthcare coverage decisions, and payer policy development.
• Strong analytical, research, writing, and documentation skills.
• Ability to manage multiple projects and work effectively across cross-functional teams.
• Experience developing, drafting, or maintaining clinical, medical, or coverage-related policies.

• Advanced clinical, scientific, or healthcare-related degree or professional credential (RN, PA, NP, PharmD, PhD, etc.).
• Experience within a health plan, managed care organization, utilization management organization, healthcare technology company, or related healthcare setting.
• Knowledge of diagnostic testing, laboratory medicine, pathology, or related healthcare services.
• Familiarity with commercial payer policies, Medicare coverage guidance, and healthcare coding concepts.
• Experience leveraging claims data, healthcare analytics, or AI-assisted research tools to support policy development.

What You'll Bring

• Strong critical thinking and evidence-evaluation skills.
• Ability to communicate complex clinical concepts in clear, concise written language.
• Experience balancing clinical evidence, operational considerations, and business value.
• Attention to detail and a commitment to producing high-quality work.
• A collaborative approach and the ability to influence stakeholders across multiple disciplines.

Location: Fully Remote (U.S.)

Travel: Occasional travel for team meetings may be required.

Compensation: Competitive base salary plus bonus opportunity.

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