Senior Clinical Informaticist

Company:
Highmark Health

CANDIDATE MUST BE US Citizen (due to contractual/access requirements)

This job promotes the understanding, integration, and application of data and information technology to solve critical healthcare business challenges across the enterprise, with a particular focus on identifying and mitigating fraud, waste, and abuse. Leveraging experience in and knowledge of clinical, technology, and data subject areas, the informaticist will play a crucial role in the design, development, and deployment of production-grade data and analytic solutions.

Specifically, this individual will work closely with auditors, analysts, and data scientists to design, develop, and deploy applications leveraging healthcare datasets. Their deep clinical background will be essential in identifying trends within healthcare claims data and providing actionable suggestions for building robust solutions to support our clinical and auditing teams. Areas of influence will include but are not limited to: data governance, data science, healthcare interoperability, and reference data management.

This person will serve as a liaison to bridge gaps between people, processes, clinical knowledge and technology across the enterprise.

• Combine knowledge of healthcare and experience in clinical settings to deliver value and insights through enterprise-grade data & analytic solutions.
• Provide subject matter expertise related to the use of clinical ontologies, vocabularies and code sets in support of internally- and externally-sourced data. Includes support for bi-directional interoperability efforts across the enterprise.
• In coordination with Enterprise Data Governance, assist with the development of business rules and associated code-based definitions related to clinical data domains. Includes but is not limited to sensitive data classification, disease states, clinical episodes, reimbursement episodes, pharmacy use, and care plans.
• Work with teams across health plan, clinical, administrative, and IT business units to understand clinical data needs, evaluate opportunities to fulfill those needs through data and analytics, and participate in the build and delivery of analytic solutions.
• Assist with design, build and deployment of robust analytic data solutions including but not limited to real-time/streaming analytics and alerting, data integration and interoperability, NLP, and AI/ML algorithms. Includes processes to convert prototypes into production solutions.
• Provide clinical process and system expertise and training.
• Other duties as assigned or requested.

• Bachelor's Degree in Nursing, Informatics, Health Information Management, Information Systems or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

• Master's Degree in Nursing, Informatics, Health Information Management, Information Systems or related field

• 5 years of working in a Clinical Care setting - e.g., ambulatory, hospital, post-acute
• 3 years of hands‑on experience with Electronic Health Record (EHR) system like EPIC, Cerner, Allscripts, or comparable

• 3 years in Clinical Workflow, Clinical Systems, and the underlying data used to support clinical decision‑making
• 3 years in Data Analysis, Analytics, Business Intelligence or Reporting
• 1 year in Fraud, Waste, and Abuse detection
• 1 year using SQL to analyze large datasets

• None

• Clinical licensure (e.g., nursing) OR
• Clinical coding certification
• Clinical Licensure (RN, LPN) or
• Clinical coding certification (RHIA, CPC, CIC, COC, etc)

• Analytically strong and familiar with clinical informatics concepts, practices, and procedures
• Experience with health care vocabularies and code sets including ICD-10, CPT/HCPCS, SNOMED-CT, LOINC, and Rx Norm
• Familiarity with healthcare interoperability concepts including HL7 v2.x, FHIR, IHE, X12
• Strong communication skills

None

None

Office-based

• Teaches / trains others regularly
• Occas…