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Principal, Clinical Policy and Services

TurningPoint
Lake Mary, FL, USA
Posted on Aug 21, 2025
     
  Position: Principal, Clinical Policy and Services  
     Location:   Lake Mary, FL
  
  
  Job Id: 668-TBD  
  # of Openings: 1  
    
  Principal, Clinical Policy and Services 
 
Who We Are: 
TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.
 
 Position Summary:
 The Principal of Clinical Policies & Services has ownership for and manages a defined portfolio of medical policy specialties across the organization. This role has responsibility for client facing interactions as they relate to all medical policy-related matters within their specific portfolios. The principal manages the development, implementation, and continuous improvement of evidence-based clinical guidelines and pathways.
 
 The role collaborates cross-functionally to ensure alignment with clinical best practices, regulatory standards, and client expectations, while also driving innovation and operational excellence across clinical programs. 
 
Roles and Responsibilities: 
Manages the development, maintenance, and governance of evidence-based medical policies and clinical guidelines across assigned specialties
Serve as the primary point of contact for clients regarding medical policy strategy, implementation, and resolution of clinical concerns.
Oversee the end-to-end lifecycle of clinical policy development, including research, stakeholder engagement, quality assurance, and publication.
Provide direction and subject matter expertise to internal teams and external partners on clinical policy trends, regulatory changes, and emerging evidence.
Collaborate with senior leadership, Medical Directors, and Utilization Management teams to ensure policy alignment with organizational goals and client needs.
Represent the company in external forums, including client meetings, industry workgroups, and regulatory discussions.
Guide the design and implementation of system enhancements and technology solutions that support clinical policy operations.
Participate in Utilization Management Committee (UMC) meetings and other governance forums to ensure clinical integrity and compliance.
Analyze implementation trends and program performance data to assess policy operationalization and identify areas for communication or process improvement
Serve as a clinical thought leader across the organization, guiding strategic initiatives and advising internal teams on policy-related matters
Uphold HIPAA and company confidentiality standards in all communications and documentation.
Education, Experience and Licensure: 
Clinical experience in Cardiac and MSK specialties is desirable.
Bachelor’s degree in nursing or a related clinical field.
Active clinical license
Minimum 5 years of experience in medical policy development, clinical guideline authorship, or utilization management in a managed care or payer environment.
Demonstrated experience in client-facing roles, with strong communication and relationship management skills.
Proven ability to lead cross-functional initiatives and influence decision-making at all levels of the organization.
Strong analytical, organizational, and project management skills.
Proficiency in Microsoft Office Suite; experience with clinical policy platforms and healthcare data systems preferred.
Preferred Skills: 
Master’s degree in Nursing or related clinical field
Experience in Utilization Management/Managed Care Environments
Experience with Quality Assurance
Knowledge of various EMR systems and experience with system evaluation and enhancements
#LI-Remote 
 
TurningPoint Healthcare Solutions is an Equal Opportunity Employer. 

 
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