Clinical manager h1.location_city

Company :

Highmark Health

Job Description :

JOB SUMMARY

CANDIDATE MUST BE US Citizen (due to contractual/access requirements)

This job promotes the understanding, integration, and application of data and information technology to solve critical healthcare business challenges across the enterprise, with a particular focus on identifying and mitigating fraud, waste, and abuse . Leveraging experience in and knowledge of clinical, technology, and data subject areas , the informaticist will play a crucial role in the design, development, and deployment of production-grade data and analytic solutions . Specifically, this individual will work closely with auditors, analysts, and data scientists to design, develop, and deploy applications leveraging healthcare datasets. Their deep clinical background will be essential in identifying trends within healthcare claims data and providing actionable suggestions for building robust solutions to support our clinical and auditing teams. Areas of influence will include but are not limited to: data governance, data science, healthcare interoperability, and reference data management . This person will serve as a liaison to bridge gaps between people, processes, clinical knowledge and technology across the enterprise.

ESSENTIAL RESPONSIBILITIES

• Combine knowledge of healthcare and experience in clinical settings to deliver value and insights through enterprise-grade data & analytic solutions.

• Provide subject matter expertise related to the use of clinical ontologies, vocabularies and code sets in support of internally- and externally-sourced data.Includes support for bi-directional interoperability efforts across the enterprise.

• In coordination with Enterprise Data Governance, assist with the development of business rules and associated code-based definitions related to clinical data domains.Includes but is not limited to sensitive data classification, disease states, clinical episodes, reimbursement episodes, pharamacy use, and care plans.

• Work with teams across health plan, clinical, administrative, and IT business units to understand clinical data needs, evaluate opportunities to fullfill those needs through data and analytics, and participate in the build and delivery of analytic solutions.

• Assist with design, build and deployment of robust analytic data solutions including but not limited to real-time/streaming analytics and alerting, data integration and interoperability, NLP, and AI/ML algorithms.Includes processes to convert prototypes into production solutions.

• Provide clinical process and system expertise and training.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Nursing, Informatics, Health Information Management, Information Systems or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• Master's Degree in Nursing, Informatics, Health Information Management, Information Systems or related field

EXPERIENCE

Required

• 5 years of working in a Clinical Care setting - e.g., ambulatory, hospital, post-acute

• 3 years of hands-on experience with Electronic Health Record (EHR) system like EPIC, Cerner, Allscripts, or comparable

Preferred

• 3 years in Clinical Workflow, Clinical Systems, and the underlying data used to support clinical decision-making

• 3 years in Data Analysis, Analytics, Business Intelligence or Reporting

• 1 year in Fraud, Waste, and Abuse detection

• 1 year using SQL to analyze large datasets

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• Clinical licensure (e.g., nursing) OR

• Clinical coding certification

• Clinical Licensure (RN, LPN) or

• Clinical coding certification (RHIA, CPC, CIC, COC, etc)

SKILLS

• Analytically strong and familiar with clinical informatics concepts, practices, and procedures

• Experience with heatlhcare vocabularies and code sets including ICD-10, CPT/HCPCS, SNOMED-CT, LOINC, and RxNorm

• Familiarity with healthcare interoperability concepts including HL7 v2.x, FHIR, IHE, X12

• Strong communication skills

Language (Other than English):

None

Travel Requirement:

None

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$67,500.00

Pay Range Maximum:

$126,000.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J276967