FREE ACCESS
5,000–10,000 jobs/day
See all jobs on JobTailor
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Medical Policy & Special Project Clinical Analyst – RN
Blue Cross and Blue Shield of NebraskaClinical Analyst for medical policy development and complex claims configuration at Blue Cross and Blue Shield of Nebraska. Collaborating across various departments to ensure policy alignment and operational effectiveness.
Posted 7/8/2026full-timeRemote • Florida, Iowa, Kansas, Montana, New York, North Dakota, Texas • 🇺🇸 United StatesMid-LevelSeniorWebsite
About the role
Key responsibilities & impact- Lead the development, interpretation, maintenance, and ongoing evaluation of medical policies using evidence-based clinical literature, national guidelines, regulatory requirements, and coding updates
- Analyze emerging technologies, new procedures, pharmaceuticals, and clinical treatments to determine policy implications and organizational impact
- Serve as the clinical authority for complex medical policy interpretation and implementation
- Recommend policy revisions that improve consistency, quality, compliance, and operational efficiency
- Lead evaluation and implementation of ICD-10, CPT, HCPCS, NCCI, CMS, and other industry coding updates impacting claims adjudication
- Provide strategic oversight for coding edits and clinical business rules within HealthRules and other claims administration systems
- Partner with Configuration and IT teams to translate clinical requirements into system functionality
- Identify opportunities to improve automation, reduce manual intervention, and strengthen payment accuracy
- Lead enterprise-wide initiatives involving medical policy, payment integrity, claims modernization, and regulatory compliance
- Provide expert consultation to executive leadership and business partners regarding complex clinical policy issues
- Serve as the clinical liaison across operational, technical, and vendor teams during implementation of strategic initiatives
- Evaluate business impacts and recommend solutions that balance clinical appropriateness, member experience, provider relationships, and operational effectiveness
- Direct clinical validation, user acceptance testing, and end-to-end testing activities for policy and configuration changes
- Ensure policy implementations are accurate, compliant, and operationally effective prior to production deployment
- Monitor implementation outcomes and identify opportunities for continuous improvement
- Mentor analysts and other team members on medical policy interpretation, coding methodologies, and clinical best practices
- Build collaborative partnerships across internal departments and external vendors
Requirements
What you’ll need- Current Registered Nurse (RN) license in good standing
- Bachelor's degree in Nursing (BSN) required; Master's degree in Nursing, Healthcare Administration, Public Health, or related field preferred
- Minimum of 5–7 years of progressive clinical nursing experience in an acute care, specialty care, or other complex healthcare setting
- Minimum of 3 years of experience in medical policy, utilization management, payment policy, health insurance operations, clinical coding, or related healthcare administration
- Advanced knowledge of: ICD-10-CM/PCS CPT HCPCS National Correct Coding Initiative (NCCI) CMS payment methodologies Medical necessity criteria and evidence-based clinical practice
- Experience supporting or implementing claims systems, configuration, or healthcare technology solutions
- Strong analytical, problem-solving, project management, and communication skills.
Benefits
Comp & perks- Health insurance
- Paid time off
- Flexible work arrangements
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medical Policy InterpretationClinical Best PracticesEvidence-Based Clinical LiteratureCoding MethodologiesClaims AdjudicationUtilization ManagementPayment PolicyHealthcare Technology SolutionsProject ManagementUser Acceptance Testing
Soft Skills
Communication SkillsMentoringCollaborationStrategic OversightProblem-Solving
Certifications
Bachelor's Degree in Nursing (BSN)Master's Degree in Nursing or Related Field (Preferred)