Clinical Quality Management Analyst (Healthcare)

Location: Remote work from Pennsylvania, United States; travel requirement is 0%–25% and physical work site requirements may apply.

Company

hirify.global provides healthcare and health insurance services with a focus on quality, compliance, and member and provider outcomes.

What you will do

• Develop and manage process improvement initiatives for members and providers.
• Analyze clinical data, medical records, documentation, and HCC coding to support quality and revenue programs.
• Conduct office site reviews, medical record reviews, retrospective, concurrent, prospective, semi-annual, and annual audits.
• Monitor CMS and other regulatory or accreditation requirements and update compliance plans.
• Educate providers on STARS, HEDIS, HCC coding, documentation, and quality improvement.
• Coordinate or support credentialing, complaint investigations, site visits, re-audits, and accreditation activities.

Requirements

• Current state RN or LPN license, enhanced Nurse Licensure Compact multi-state license, or a bachelor's degree in a healthcare-related field.
• Six years of experience in HEDIS or quality abstraction, HCC or medical coding, or a related healthcare field may substitute for the degree.
• Current RN/LPN licensure or CPC, CRC, RHIA, RHIT, or CCS certification; certification may be obtained within four months of hire.
• Three years of nursing or healthcare-related experience and one year of project management experience.
• Knowledge of Total Quality Management, process and outcome measurement, clinical data analysis, statistics, and Microsoft Office.
• Strong written and verbal communication, analytical, problem-solving, and medical documentation skills.

Culture & Benefits

• Remote work arrangement with occasional travel to work sites.
• Work includes collaboration with medical administrators, Medical Directors, Physician Advisors, providers, and office staff.
• Responsibilities require compliance with HIPAA, information security policies, federal and state regulations, and the company code of conduct.