Allegheny Health Network is looking for a Clinical Quality Management Analyst - Registered Nurse to collaborate across departments on compliance, process improvement, and quality initiatives. In this role, you will serve as a key resource for improving medical care documentation, coding accuracy, and adherence to federal and state standards.
What You'll Do
- Develop and manage process improvement initiatives, including detailed data analysis, report generation, and medical record documentation.
- Collect and analyze information from office site and medical record reviews to improve care, proper documentation, and ICD-10-CM coding.
- Monitor regulatory changes from bodies like CMS and adjust compliance plans accordingly.
- Conduct retrospective, concurrent, and prospective audits, identify gaps, and communicate results.
- Perform special studies, office site visits, and medical record reviews to ensure timely performance improvement.
- May coordinate credentialing, complaint investigations, and accreditation activities on behalf of the organization.
What We're Looking For
- Current state RN or LPN license or a Bachelor’s degree in a Healthcare-related field.
- 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or a healthcare-related field in lieu of a bachelor's degree.
- 3 years of experience in nursing or a healthcare-related field.
- Current State of PA RN or LPN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
- CPC, CRC, RHIA, RHIT, or CCS Certification or must obtain within 4 months upon hire.
Nice to Have
- 1 year of project management experience.
Technical Stack
- Microsoft Office software (Word, Excel, Access, PowerPoint, etc.)
Benefits & Compensation
- Salary range: $50,200.00 - $91,200.00
Work Mode
This is a fully remote position.
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