Clinical Quality Management Analyst - Registered Nurse (Remote)

About the Role

Join Highmark Health as a Clinical Quality Management Analyst - Registered Nurse (Remote) in United States. Company: Highmark Inc. Job Description: JOB SUMMARY This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product lines.

Key Responsibilities

• CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value

• based care and achieve and maintain accreditation. Monitor changes, corrections and clarifications in applicable regulatory/accrediting body

Requirements

• annual, and annual audits, identify gaps and communicate results. Conduct continuing education to providers on STARS, HEDIS, and HCC Coding. Conduct re

• audits as needed Other duties as assigned or requested. EDUCATION Required Current state RN or LPN license or Bachelor’s degree in a Healthcare

• related field Preferred 1 year of project management experience LICENSES OR CERTIFICATIONS Required Current State of PA RN or LPN licensure OR Current multi

• developed, analytical and problem

Benefits & Compensation

• Salary: $50.2K - $91.2K

Work Schedule

• Full-Time position.

• Remote position - work from anywhere.

• Day shift only - no nights.

This position offers day shifts only. Work with Highmark Health in United States.