Clinical Compliance Coordinator (Remote)

Job description

Company: Highmark Inc. Job Description: JOB SUMMARY This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves as a corporate resource regarding accreditation standards, clinical performance and continuous improvement principles. Manages the oversight and development of clinical submissions for regulator inquiries. Oversees development and maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA requirements. Monitors regulatory changes, industry trends, and contract changes on an ongoing basis. Conducts analysis and oversight of design, development, modification, adaptation, implementation and execution of solutions for improvement of short-term and long-term clinical and operational excellence. Collaborates with various organizational leaders to prepare briefings or reports and conduct data analyses. ESSENTIAL RESPONSIBILITIES: - Serve as an internal project lead to ensure alignment and consistency in the organization's contractual clinical performance measurement across Care Management. - Manage and coordinate department activities including but not limited t...