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Highmark Health
Highmark Health
H1B वीज़ा प्रायोजकपरामर्शबीमालॉजिस्टिक्स
Highmark Health एक स्वास्थ्य सेवा संगठन है, जिसका ध्यान लोगों के लिए स्वास्थ्य सेवाओं के अनुभव और उन तक पहुंच को बेहतर बनाने पर है। इसका कार्य नैदानिक सेवाओं, प्रौद्योगिकी, वित्त, विपणन और स्वास्थ्य सेवाओं के वितरण में सहायक अन्य कार्यों तक फैला हुआ है। Blue Cross Blue Shield Association के एक स्वतंत्र लाइसेंसधारी के रूप में, कंपनी स्वास्थ्य सेवा प्रणाली को विकसित करने में सहायता करने के लिए विभिन्न क्षेत्रों के पेशेवरों को साथ लाती है। Highmark Health विविधता, समानता और समावेशन को भी महत्व देती है तथा दिव्यांग समावेशन और सैन्य-अनुकूल रोजगार के लिए मान्यता प्राप्त कर चुकी है।
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कंपनी की नौकरियाँ

Clinical Quality Management Analyst, RN

Improve healthcare quality and compliance through clinical data analysis, medical record reviews, coding, audits, and accreditation work at Highmark Health. Support providers and quality initiatives with education and process improvement.

USसंयुक्त राज्यALअलबामाAKअलास्काAZएरिज़ोनाCAकैलिफ़ोर्नियाCOकोलोराडोCTकनेक्टिकटFLफ़्लोरिडाHIहवाईIDआइडाहोILइलिनॉयIAआयोवाKSकंसासKYकेंटकीLAलुइज़ियानाMEमेनMDमैरीलैंडMAमैसाचुसेट्सMIमिशिगनMNमिनेसोटाMSमिसिसिपीMOमिसौरीNEनेब्रास्काNVनेवादाNHन्यू हैम्पशायरNJन्यू जर्सीNMन्यू मैक्सिकोNYन्यूयॉर्कNCउत्तरी कैरोलिनाNDउत्तरी डकोटाOHओहायोOKओक्लाहोमाORओरेगनPAपेंसिल्वेनियाRIरोड आइलैंडSCदक्षिण कैरोलाइनाSDदक्षिण डकोटाTNटेनेसीTXटेक्सासUTयूटाVTवर्मोंटVAवर्जीनियाWAवॉशिंगटनWVपश्चिम वर्जीनियाWIविस्कॉन्सिनWYवायोमिंग
$62,700 – $97,200 / वर्ष
ऑन-साइटपूर्णकालिकमध्य स्तरवरिष्ठआवश्यक भाषा: अंग्रेज़ीव्यवसाय विश्लेषक

विवरण

  • Partner with departments on compliance, process improvement, medical record reviews and coding, and member and provider satisfaction.
  • Recommend and implement improvements to quality care, member services, and ICD-10-CM documentation.
  • Advise and educate on medical record documentation, CMS and NCQA standards, and continuous quality improvement.
  • Conduct special studies, audits, office site visits, and medical record reviews.
  • Coordinate credentialing and re-credentialing, member complaint investigations, Medical Director and facility site visit requests, reviews, audits, and accreditation activities.
  • Develop and oversee improvement initiatives using data and process analysis, report generation, medical record documentation, and HCC coding.
  • Analyze office site and medical record review findings to improve care, services, documentation, coding, STARS, value-based care, credentialing, quality improvement, and accreditation.
  • Track regulatory and accrediting-body changes and update compliance plans in line with CMS Coding Guidelines.
  • Conduct retrospective, concurrent, prospective, semiannual, and annual audits; identify gaps and share results.
  • Educate providers on STARS, HEDIS, and HCC coding.
  • Conduct follow-up audits as needed.
  • Complete other assigned or requested duties.

आवश्यकताएँ

  • Current state RN or LPN license, or a bachelor's degree in a healthcare-related field.
  • Six years of experience in HEDIS/quality abstraction, HCC or medical coding, or a healthcare-related field may substitute for a bachelor's degree.
  • Three years of experience in nursing or a healthcare-related field.
  • Current state RN or LPN license, multistate licensure through the enhanced Nurse Licensure Compact (eNLC), or CPC, CRC, RHIA, RHIT, or CCS certification; required certification or licensure must be obtained within four months of hire.
  • Understanding of Total Quality Management (TQM) concepts, techniques, and process and outcome measures.
  • Knowledge of statistics preferred for analyzing reports and validating study methods.
  • Strong verbal and written communication skills and a professional manner.
  • Ability to communicate with medical administrators, including Medical Directors and Physician Advisors, about identifying problems, implementing action plans, monitoring progress, and resolving issues.
  • Computer literacy and familiarity with information systems and comparative databases.
  • Working knowledge of Microsoft Office, including Word, Excel, Access, and PowerPoint.
  • Analytical and problem-solving skills, including the ability to understand and interpret clinical data.
  • Travel requirement of 0%–25%.
  • Physical work site required.

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