[Hiring] Clinical Review Specialist @Mass General Brigham

Role Description

The Clinical Review Specialist will assess the medical necessity and appropriateness of healthcare services.

• Review medical records and treatment plans to ensure that they align with established guidelines and standards.
• Participates in department quality improvement initiatives.
• Reviews and applies analytical skills to designated patient population medical record documentation to assess the level of documentation accuracy and completeness.
• Provides clinician-specific education regarding quality, outcomes improvement, documentation standards, and actions to improve clinical processes.

Qualifications

• Bachelor's Degree in Nursing (BSN) or related field of study required. Experience can be accepted in lieu of degree.
• 3+ years Clinical Documentation Improvement (CDI) specialist training or risk adjustment experience, including clinical coding knowledge required.
• 2+ years experience with chart reviews in electronic medical records, clinical data, supporting or leading work around quality and improvements and creating and/or presenting education material required.
• RN license preferred.
• Coding Credential (CRC, CPC or CCS) preferred.
• Additional Knowledge, Skills and Abilities:
• Review medical records and treatment plans to ensure that they align with established guidelines and standards.
• Participates in department quality improvement initiatives.
• Reviews and applies analytical skills to designated patient population medical record documentation to assess the level of documentation accuracy and completeness.
• Provides clinician-specific education regarding quality, outcomes improvement, documentation standards, and actions to improve clinical processes.

Requirements

• Remote / Work from Home.
• Full-time, Monday through Friday, standard business hours.
• On remote workdays, employees must use a stable, secure, and compliant workstation in a quiet environment.
• Teams Video is required and must be accessed using MGB-provided equipment.

Benefits

• Competitive base pay.
• Comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate your contributions and support your professional growth.