Medical Policy Research Specialist/ Registered Nurse (RN) - Remote in Virginia

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plan is currently hiring a Medical Policy Research Specialist/ Registered Nurse (RN) - Remote in Virginia! Status: Full-time, permanent position (40 hours) Work hours: 8am to 5pm EST, M-F Location: This position is remote in Virginia, with a travel expectation of 1x a month to Sentara Park 1330 in Virginia Beach, VA for candidates residing in the Hampton Roads area. Job Responsibilities: Medical Policy Research Specialist is responsible for ongoing identification and research of medically evidence-based clinical technologies that form the basis for clinical decision-making, medical policy and benefit development and determination. Will maintain the database of clinical criteria, ensure technology and policy reviews are reviewed on an annual and ongoing basis to meet Federal, State and Accreditation Standards. Will be proficient with the Healthcare Industry's changing National Guidelines, new medical treatments, and devices, and will compile information for the Plan related to clinical indications and use of the technology, alternative technologies that address these same indications, and clinical outcomes expected given the use of the technology. Will perform a comprehensive clinical literature review, obtain legal and regulatory status of the technology, review Federal, State, and local coverage determinations, and identify current coverage policies and procedures. Collaborates with Medical Directors and teams on clinical guideline/medical policy/regulatory guidance updates. Education: BLD - Bachelor's Level Degree in Nursing REQUIRED Certificate/Licenses: Active RN in VA or Compact/Multistate REQUIRED Experience: Related experience in clinical criteria coverage- 3 years REQUIRED Managed Care - 3 years REQUIRED Knowledge of medical policy, emerging technology, and analysis of emerging evidence REQUIRED Familiarity with primary clinical literature, clinical guidelines and/or medical policies. Wo