Clinical Quality Management RN – Process Improvement & Coding

Highmark Health; Olympia (WA); Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Health is seeking a qualified professional to lead compliance, process improvement, and coding initiatives across product lines. The role focuses on improving documentation for ICD-10-CM coding, provider education, and quality measures.

The position requires an RN/LPN license or healthcare-related Bachelor's, plus 3 years in nursing or healthcare, and includes responsibilities such as audits, data analysis, and education on STARS and HEDIS.

Qualifications

• Current state RN or LPN license or Bachelor's degree in a Healthcare-related field.
• 3 years of nursing or healthcare-related experience.
• Preferred 1 year of project management experience.
• Medicaid/Medicare experience and familiarity with Managed Care Organizations are a plus.

Responsibilities

• Develop and manage process improvement initiatives with data analysis and reporting.
• Perform medical record reviews and coding to improve documentation and ICD-10-CM coding.
• Monitor regulatory and accrediting requirements and update the compliance plan.
• Conduct audits (retrospective, concurrent, semi-annual, annual) and provide continuing education on STARS, HEDIS, and HCC coding.
• Coordinate credentialing activities and other quality initiatives as needed.

Skills

TQM concepts

Statistics

Verbal communication

Written communication

MS Office

Analytical skills

Education

RN/LPN license or Healthcare Bachelor's

CPC/CRC/RHIA/RHIT/CCS certification

Job description

Highmark Health is seeking a qualified professional to lead compliance, process improvement, and coding initiatives across product lines. The role focuses on improving documentation for ICD-10-CM coding, provider education, and quality measures.

The position requires an RN/LPN license or healthcare-related Bachelor's, plus 3 years in nursing or healthcare, and includes responsibilities such as audits, data analysis, and education on STARS and HEDIS.