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Health Plan Policy Specialist

May 9, 2026

<h2>Overview</h2> <p>The Health Plans Policy Specialist is responsible for researching, developing, and maintaining policies to ensure compliance with state and federal regulations, accreditation standards, and organizational objectives. This role conducts evidence-based research, monitors regulatory changes, and collaborates with clinical, legal, and operational stakeholders to ensure policies are accurate, current, and aligned with organizational goals.</p> <h4>Required Qualifications:</h4> <ul> <li>Bachelor's degree in a related field or equivalency.</li> <li><strong>Three years of health plans, policy development & maintenance, healthcare, and/or compliance</strong>.</li> <li>Demonstrated intermediate skills in Internet database searches.</li> </ul> <p> </p> <p><strong>Schedule</strong>: Monday - Friday 8:00 am - 5:00 pm</p> <ul> <li>Remote- Must reside in Utah </li> </ul> <p><strong>Benefits </strong><em>(ProRated based on FTE):</em></p> <ul> <li>Save 50% on Tuition (Tuition reduced for eligible employees attending the University of Utah)</li> <li>Health Coverage, Dental Coverage, Life Insurance</li> <li>Retirement</li> <li>Paid Time Off</li> <li>11 Paid Holidays per year</li> </ul> <p> </p> <p><strong>Corporate Overview:</strong> University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.</p> <p> </p> <p> </p> <p><em>As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA</em></p> <h2>Responsibilities</h2> <ul> <li>Research and draft medical, administrative, and reimbursement policies based on clinical evidence, regulatory requirements, and industry standards.</li> <li>Ensure policies align with company guidelines, NCQA standards, and applicable laws.</li> <li>Collaborate with internal stakeholders to review and approve policies.</li> <li>Monitor legislative and regulatory changes impacting health plan policies.</li> <li>Support governance committees for policy review and approval.</li> <li>Maintain accurate documentation and version control of all policies.</li> <li>Provide subject matter expertise for policy interpretation and application.</li> <li>Assist in remediation of gaps in existing processes related to policy compliance.</li> <li>Respond to inquiries regarding policy requirements.</li> </ul> <h3>Knowledge / Skills / Abilities</h3> <ul> <li>Strong analytical and technical writing skills.</li> </ul> <ul> <li>Knowledge of healthcare economics, reimbursement practices, and regulatory compliance.</li> </ul> <ul> <li>Proficiency in Microsoft Office and policy management tools.</li> </ul> <h2>Qualifications</h2> <h4>Required</h4> <ul> <li>Bachelor's degree in a related field or equivalency.</li> <li>Three years of health plans, policy development & maintenance, healthcare, and/or compliance.</li> <li>Demonstrated intermediate skills in internet database searches.</li> </ul> <h2>Qualifications (Preferred)</h2> <ul> <li>Bachelor's degree in a clinical science (e.g. nursing, medical technology), or health related field, or the equivalency.</li> <li>Certified professional coder.</li> </ul> <h3>Working Conditions and Physical Demands</h3> <p><em>Employee must be able to meet the following requirements with or without an accommodation.</em></p> <ul> <li>This is a position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position may involve standing or sitting for long periods of time and is not exposed to adverse environmental conditions.</li> </ul> <h2>Physical Requirements</h2>Carrying, Lifting, Listening, Pulling and/or Pushing, Sitting, Speaking, Standing

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...