Clinical Policy Analyst, Specialty Pharmacy

Concert is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of diagnostic testing and precision medicine. We are whole-heartedly dedicated to enhancing the transparency and efficiency of health care. Our customers include health plans, provider systems, laboratories, and other important stakeholders. We are a growing organization driven by smart, creative people to help advance precision medicine and health care. Learn more about us at www.concert.co.

YOUR ROLE

Concert is seeking a Clinical Policy Analyst in Specialty Pharmacy to support development of a portfolio of content solutions for transparent coverage and reimbursement of specialty therapeutics. You will be a voice for key clinical content and data assets within the team. This is an incubation-focused role, responsible for the initial structure, definitions, and focus for specialty pharmacy medical and reimbursement policies. In this role you will be building the policy foundation that enables scalable, evidence-based coverage decisions at scale.

You will be joining an innovative, energetic and passionate team who will help you grow and build skills at the intersection of diagnostics, information technology, and supporting clinical care.

You will work at the intersection of clinical expertise, payer strategy, and claims intelligence. You will partner closely with Analytics, Content, Platform and Commercial teams to identify policy development opportunities

You bring deep clinical knowledge in specialty pharmaceutical therapies and understand the health plan approach to specialty pharmacy, medical vs. pharmacy benefits, coding complexities, site of service, medical and reimbursement policies, and the prior authorization framework.

After 3 months on the job you will have:

• Developed an understanding of Concert’s Data Asset and Content Management philosophy, market strategy, information architecture and content maintenance cycles
• Learned to navigate to available content and data assets within the internal Concert Platform and developed an understanding of Concert’s Core Principles
• Engaged with Concert’s standard operating procedures, templates, and guided approach to evidence interpretation as it applies to specialty pharmacy policy development
• Integrated the company mission and strategy into your contributions to specialty pharmacy policy development

After 6 months you will have:

• Used Concert tools to develop and maintain content assets within the internal tooling, supporting the company’s mission of automation
• Participated in all parts of the content innovation and content management work cycles
• Utilized and supported maintenance of Concert’s claim edit strategies, claims matching system, and taxonomy structure
• Applied medical and specialty benefit claims analysis, including PBM data for the development of coverage criteria and claim edits, while considering gaps, uncertainties, and clinical risk within specialty pharmacy.
• Articulated tradeoffs between speed, depth, and clinical risk to internal stakeholders and leadership
• Independently carried out drafting of specialty pharmacy content

After 12 months you will have:

• Made significant contributions to Concert’s content library, workflow strategies, internal process innovations, and maintenance tasks
• Communicated about policy and claim edit updates and questions within and external to Concert
• Become a go-to resource within the company for questions about Concert’s specialty pharmacy medical and reimbursement policies and claim edit development as well as clinical maintenance strategies.

EXPERIENCE THAT HELPS

Candidates may have developed these skills through education and experience such as:

• A Pharmacist (PharmD preferred), Registered Nurse, Nurse Practitioner, or Physician Assistant
• Health plan or PBM operations, specifically managing specialty pharmaceutical agents, formulary structures, and prior authorization framework
• Medical and reimbursement policy development, including the research and critical evaluation of clinical literature
• Revenue Cycle Management or Payment Integrity roles focused on specialty drug claim edit reviews and audits.
• Healthcare data analysis, specifically working with standard coding entities such as HCPCS J & Q codes, ICD-10, and CMS LCDs/NCDs

WAYS CANDIDATES MAY HAVE BUILT THESE SKILLS

Candidates often build these capabilities through experiences such as:

• Advanced clinical roles specializing in specialty therapeutics and associated administrative services.
• Policy-writing positions at health plans where they managed step therapy protocols and "buy-and-bill" vs. "white bagging" strategies.
• Claims intelligence or billing roles that require navigating the intersection between medical and pharmacy benefits.
• Innovative, fast-paced environments where they have built clinical or technical solutions from the ground up.
• Technical data roles involving the analysis of raw and processed claims data to identify clinical risk.

HOW WE WORK

At Concert, the following Guiding Principles drive our work:

Listen intently. Think clearly.

We listen to understand and make thoughtful decisions. In this role, that means learning from clinicians, engineers, analysts, and partners before acting.

Act courageously. Admit mistakes.

We act boldly while remaining honest about what works and what does not. We learn quickly and improve systems openly.

Keep promises. Keep going.

Trust is built by following through. This role requires reliable execution, clear communication, and consistent delivery.

HOW THESE GUIDING PRINCIPLES SHOW UP IN THIS ROLE

• Listening across disciplines: Partnering closely with Analytics, Content, and Platform teams to understand Concert's information architecture and data assets before developing policy. Coming in with technical bravery to learn new platforms and explore new tools to bring efficiency and integrity to content development and management.
• Turning complexity into clarity: Distilling complex coding (HCPCS, ICD-10) and billing practices into scalable, evidence-based coverage decisions.
• Raising issues early: Identifying gaps, uncertainties, and clinical risks within specialty pharmacy claims analysis and articulating those tradeoffs to leadership.
• Improving systems, not relying on heroics: Building a policy foundation and claim edit strategies that enable automation and scalable reimbursement decisions.
• Following through on commitments: Delivering reliable, well-documented specialty pharmacy content and maintaining the company’s content library and maintenance cycles.

WHY THIS ROLE IS AN EXCELLENT OPPORTUNITY

Specialty pharmacy reimbursement and coverage are shifting rapidly as health plans grapple with complex coding, varied site-of-service models, and the divide between medical and pharmacy benefits.

This incubation-focused role sits at the intersection of clinical expertise, payer strategy, and claims intelligence, allowing you to build the very foundation for scalable, evidence-based coverage decisions.

For candidates who enjoy translating deep pharmaceutical knowledge into transparent content solutions, this role provides a unique opportunity to be a voice for key clinical content and influence how a growing organization advances precision medicine and healthcare efficiency

LOCATION

This company headquarters is in Nashville, Tennessee. However, Concert supports working remotely and is flexible in terms of location in order to find the right candidate.

For further questions, please contact Gillian W. Hooker, Chief Scientific Officer at ghooker@concert.co or Nicole Magdziarz, VP, Precision Therapy Solutions at nmagdziarz@concert.co.