Associate Manager at Hexagon Executive Search
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Clinical Specialist - Hospital - GNM (3-10 yrs)
What You- ll Be Doing:
- Review clinical accuracy and validity of clinical rules algorithms.
- Surveillance of US medical society best practice guidelines (i.e., USPSTF, ADA, ACOG, ACC, etc) relating to clinical quality algorithms.
- Provide clinical context for maintenance and creation of code sets relating to US clinical quality measures (ICD10, CPT, LOINC, etc).
- Researching and reviewing appropriate clinical algorithms for various business & clinical use cases to support rules construction.
- Assist with quality assurance related to rule engine algorithms including performance and reporting to assess and quantify the impact of upstream data issues.
- Support Clinical Informatics team with creation/documentationand maintenance of technical specifications for algorithms that describe a patient's clinical data and experience.
- Surveillance and assessment of industry standard quality programs and metrics.
The Experience You- ll Need (Required):
- Nursing Degree with 1-3 years of direct patient care experience or Public Health related experience
- Experience with US medical claims coding systems - ICD10, CPT, Revenue Codes, Place of Service Codes, etc.
- Excellent attention to detail and dedication to team-based production of high quality deliverables
- Superb oral and written communication, organizational, and analytical skills
- Experience with MS Office product suite, especially with Excel, Word, PowerPoint
Finishing Touches (Preferred) :
- Experience with clinical quality measures (e.g., HEDIS, PQRS,CMS etc.)
- Experience with additional US Medical claims coding systems - SNOMED codes, LOINC codes, etc.
- Experience with US Rx claims coding system - RxNorm, GPI codes.
- Strong understanding in researching data issues; excellent analytical and QA skills; and ability to take large sets of data and find anomalies and troubleshoot data issues to ensure data integrity.
- Experience in analyzing, defining and documenting business processes and rules.
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