Clinical Policy Development Analyst POST NUMBER: 307470
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
Required
- 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.
Preferred
- 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.
By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions.
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For residents of Ontario, Canada: Based on Highspring’s discussions with its Client, Highspring’s understanding is that this position for employment is a current vacancy (either through Highspring as a contractor or with the client directly).
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Pay Transparency Notice
Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:
- the individual’s skill sets, experience and training;
- licensure and certification requirements;
- office location and other geographic considerations;
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With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.