Clinical Quality & Process Improvement Analyst

Highmark Health

Kentucky

Remote

USD 63,000 - 97,000

Full time

6 days ago

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Job summary

Highmark Health seeks a qualified professional to lead process-improvement initiatives across compliance, coding, and quality programs. You will analyze medical record documentation and coding accuracy to enhance STARS, HEDIS, and overall care quality for members and providers.

The role requires RN/LPN or healthcare-related degree, plus 3+ years in nursing or related field. Strong data analysis and education duties are part of the job, with travel 0–25%.

Qualifications

Current RN or LPN license OR healthcare bachelor's degree.
Alternate: 6 years in HEDIS/Quality abstraction or related field.
Preferred: none stated.

Responsibilities

Develop and manage process improvement initiatives for members and providers.
Analyze data from office site reviews and medical records for documentation and coding improvements.
Coordinate with credentialing, STARS, and quality programs to improve outcomes.
Conduct audits (retrospective, concurrent, prospective) and communicate results.
Provide continuing education to providers on STARS, HEDIS, and HCC coding.
Perform other duties as assigned.

Skills

Healthcare experience

Nursing license

Project management

Medicaid experience

Medicare experience

Managed care knowledge

Data analysis

Clinical data interpretation

Communication skills

Office software proficiency

Education

RN/LPN license or Bachelor's in health

Certifications in health info (optional)

Tools

Microsoft Office

Data systems knowledge

Job description

The role requires RN/LPN or healthcare-related degree, plus 3+ years in nursing or related field. Strong data analysis and education duties are part of the job, with travel 0–25%.

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