Senior Clinical Informatics Specialist

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<p><b>Company:</b> Highmark Health</p><p><b>Job Description:</b></p><p><b>JOB SUMMARY</b></p><p><i><b>CANDIDATE MUST BE US Citizen (due to contractual/access requirements)</b></i></p><p>This role is essential in enhancing the integration of data and technology to address significant healthcare challenges, particularly in combating <b>fraud, waste, and abuse</b>. Drawing on your deep experience within <b>clinical, technology, and data domains</b>, you will be instrumental in the <b>design, development, and implementation of advanced data and analytical solutions</b>. Collaborating closely with <b>auditors, analysts, and data scientists</b>, you will develop applications that utilize healthcare data to uncover patterns and provide actionable insights for clinical and auditing teams. Your expertise will also influence key areas such as <b>data governance, data science, healthcare interoperability, and management of reference data</b>. You will act as a crucial link between clinical knowledge, technology, and operational processes.</p><p><b>ESSENTIAL RESPONSIBILITIES</b></p><ul><li><p>Utilize your healthcare knowledge and clinical experience to derive value through enterprise-grade data and analytical solutions.</p></li><li><p>Offer subject matter expertise related to clinical ontologies, vocabularies, and code sets for internal and external data, supporting interoperability across the organization.</p></li><li><p>Collaborate with Enterprise Data Governance to develop business rules and metadata associated with clinical data domains, focusing on sensitive data, disease states, and care plans.</p></li><li><p>Engage with various health plan, clinical, administrative, and IT teams to assess clinical data needs and develop analytical solutions that meet those needs.</p></li><li><p>Assist in designing, building, and deploying robust analytical data solutions, including real-time analytics, data integration, and AI/ML algorithms.</p></li><li><p>Provide clinical systems expertise and training to staff.</p></li><li><p>Perform other related duties as assigned.</p></li></ul><p><b>EDUCATION</b></p><p><b>Required</b></p><ul><li>Bachelor's Degree in Nursing, Informatics, Health Information Management, Information Systems, or a related field, or equivalent experience and/or education.</li></ul><p><b>Preferred</b></p><ul><li>Master's Degree in Nursing, Informatics, Health Information Management, Information Systems, or related field.</li></ul><p><b>EXPERIENCE</b></p><p><b>Required</b></p><ul><li>5 years of experience in a Clinical Care setting (e.g., ambulatory, hospital, post-acute).</li><li>3 years of experience with Electronic Health Record (EHR) systems like EPIC, Cerner, Allscripts, or similar.</li></ul><p><b>Preferred</b></p><ul><li>3 years in Clinical Workflow, Clinical Systems, and the data supporting clinical decisions.</li><li>3 years in Data Analysis, Analytics, Business Intelligence, or Reporting.</li><li>1 year experience in Fraud, Waste, and Abuse detection.</li><li>1 year using SQL for large dataset analysis.</li></ul><p><b>LICENSES or CERTIFICATIONS</b></p><p><b>Required</b></p><ul><li>None</li></ul><p><b>Preferred</b></p><ul><li>Clinical licensure (e.g., nursing) <b>OR</b></li><li>Clinical coding certification.</li><li>Clinical Licensure (RN, LPN) or Clinical coding certification (RHIA, CPC, CIC, COC, etc).</li></ul><p><b>SKILLS</b></p><ul><li>Strong analytical skills and familiarity with clinical informatics concepts.</li><li>Experience with healthcare vocabularies and coding systems including ICD-10, CPT/HCPCS, SNOMED-CT, LOINC, and RxNorm.</li><li>Understanding of healthcare interoperability concepts including HL7 v2.x, FHIR, IHE, X12.</li><li>Excellent communication skills.</li></ul><p><b>Language (Other than English):</b> None</p><p><b>Travel Requirement:</b> None</p><p><b>PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS</b></p><p><b>Position Type</b></p><p>Office-based</p><p>Requires teaching or training others regularly.</p><p>Occasionally travel between office and various work sites.</p><p>Physical work site required.</p><p>Lifting required: up to 10 pounds (Constantly), 10 to 25 pounds (Occasionally), and 25 to 50 pounds (Rarely).</p><p><b><i>Disclaimer:</i></b> This job description reflects general duties and responsibilities but may not include all tasks and qualifications required.</p><p><b><i>Compliance Requirement:</i></b> This role adheres to ethical and legal standards and Company policies.</p><p><i>This position may require access to confidential information, necessitating compliance with HIPAA and Company Privacy Policies.</i></p><p><i>It is the employee's responsibility to adhere to the Company's Code of Business Conduct, including compliance with applicable laws and policies.</i></p><p><b>Pay Range Minimum:</b> $67,500.00</p><p><b>Pay Range Maximum:</b> $126,000.00</p><p><i>Pay is influenced by qualifications, experience, contributions, and market factors.</i></p><p>Highmark Health promotes equal opportunities and prohibits discrimination based on veteran status or disability, alongside protecting against discrimination across all applicable categories.</p><p>We aim to ensure accessibility for all users. For assistance, please contact HR Services Online via email.</p><p><b>Req ID:</b> J276967</p>

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