Clinical Policy Configuration Specialist (Medtech)

TL;DR

Clinical Policy Configuration Specialist (Medtech): Ensuring medical coverage policies are accurately configured and maintained within the platform with an accent on clinical compliance and data accuracy. Focus on collaborating with clinical experts and engineering teams to optimize policy implementation and improve healthcare decision-making at scale.

Location: Remote (USA). Not eligible for hire in: AK, CA, CO, HI, NY, or WA.

Salary: $70,000–$80,000 annually.

Company

A clinical intelligence platform and agentic AI-powered solution provider that streamlines payer-provider decision-making to improve the speed, cost, and quality of care.

What you will do

• Configure and maintain medical coverage policies within the product platform to ensure accuracy and compliance.
• Conduct quality assurance reviews and testing to validate policy functionality and clinical appropriateness.
• Monitor medical coverage policy updates and adjust configurations accordingly.
• Serve as a subject matter expert, providing guidance to internal teams and customers.
• Address inquiries regarding policy configurations to ensure alignment with payers and providers.
• Collaborate cross-functionally with product managers, engineers, and clinical experts to optimize policy usability.

Requirements

• Must be based in the United States (excluding AK, CA, CO, HI, NY, WA).
• 2+ years of experience in utilization management, medical policy development, or health technology assessment.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with healthcare data structures and clinical coding (ICD-10, HCPCS, CPT).
• Bachelor's Degree in Nursing (BSN) or equivalent clinical background.
• Proficiency with Microsoft Office, Google Drive, Confluence, and Jira.

Culture & Benefits

• Fully remote work environment with approximately 5% travel.
• Comprehensive medical, dental, vision, life, and disability insurance.
• 401K retirement plan with company match.
• Flex Time Off policy plus company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance and Employee Assistance Program.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the Hiring Manager.
• Team and cross-functional interviews.