Clinical Review Specialist

Mass General Brigham•Somerville, MA

1d•$63,648 - $90,750•Remote

About The Position

The Clinical Review Specialist will assess the medical necessity and appropriateness of healthcare services. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Requirements

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.

Nice To Haves

RN license preferred.
Coding Credential (CRC, CPC or CCS) preferred.

Responsibilities

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.