Clinical Policy Development Analyst
- Hiring from
- United States
- Work type
- Remote
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About Avalon Healthcare Solutions:
Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.
Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.
With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.
For more information about Avalon, please visit www.avalonhcs.com
Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.
This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.
About the Clinical Policy Development Analyst, Routine Testing Position:
The Clinical Policy Development Analyst will identify and develop new evidence-based policies that expand Avalon’s Routine Test Management policy library. The analyst will monitor developments in laboratory testing, evaluate clinical evidence and coverage guidance, assess potential policy opportunities, and draft policies for clinical review and approval. The role will also coordinate with Product, Coding & Translation, and claims-editing teams to ensure approved policies can be implemented consistently.
This position is eligible for remote work, but quarterly travel will be required to Avalon’s corporate office located in Tampa, Florida.
Clinical Policy Development Analyst, Routine Testing – Essential Functions and Responsibilities:
- Research emerging laboratory tests, technologies, clinical guidelines, coding changes, payer policies, and utilization trends.
- Identify and prioritize opportunities for new routine testing policies based on clinical evidence, market need, claims data, and potential client value.
- Review and summarize peer-reviewed literature, professional society guidance, CMS coverage requirements, and other authoritative sources.
- Draft clinical policies that clearly define scope, medical necessity criteria, coverage requirements, exclusions, limitations, and supporting references.
- Present policy recommendations for clinical review and revise draft policies through approval and publication.
- Review the existing policy library for coverage gaps, outdated references, or opportunities to expand or consolidate policies.
- Maintain organized research, citations, decision records, and version-controlled policy documentation.
- Partner with Product, Scientific Affairs, Coding & Translation, and claims-editing teams to support policy implementation and answer questions about policy intent.
- Use approved AI and large language model tools to support research, policy comparison, and evidence synthesis while validating outputs against authoritative sources.
Clinical Policy Development Analyst, Routine Testing – Minimum Qualifications:
- Demonstrated ability to evaluate clinical literature and translate evidence into clear policy language.
- Familiarity with diagnostic testing, medical necessity, and health plan coverage policies.
- Strong research, analytical, writing, and documentation skills.
- Ability to manage multiple policy-development projects and work effectively across clinical, product, technical, and operational teams.
Clinical Policy Development Analyst, Routine Testing – Preferred Qualifications:
- Advanced clinical or scientific degree or relevant professional credential.
- Experience developing clinical policies for a health plan, laboratory benefit manager, utilization management organization, or healthcare technology company.
- Knowledge of routine laboratory testing, pathology, and diagnostic coding.
- Familiarity with CMS NCDs and LCDs, commercial payer policies, and professional society guidelines.
- Experience using claims data or AI-assisted research tools to identify and evaluate policy opportunities.