Senior Clinical Informatics Specialist

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

Created: 2026-03-07