Clinical Reviewer

Cincinnati Children's

2d•$76,336 - $97,490•Onsite

About The Position

The Clinical Reviewer works in Surgical Services at Cincinnati Children’s’ Burnet Campus, coordinating data collection and analysis, supporting quality improvement and research, and conducting clinical, utilization, and compliance reviews. The role uses clinical and statistical information to identify trends and quality issues, communicate findings, and support improved care and organizational performance. It also involves collaboration with hospital teams, physicians, clinicians, and other stakeholders, and may include developing educational materials and delivering presentations. The position is regular, full time, and scheduled for 40 hours per week on the day shift. The expected starting pay range is $76,336.00–$97,489.60 annually. Starting pay depends on experience, skills, and equity; exceptions may apply for highly qualified candidates. Additional pay and benefits may apply, and annual pay may vary based on FTE status.

Requirements

Bachelor’s degree or an equivalent combination of education and experience.
At least 5 years of work experience in a related job discipline.
May require a clinical license, certification, or training.

Responsibilities

Direct and coordinate data collection, data harvesting, quarterly outcomes report analysis and review, and monthly statistical and analytical reporting for the department.
Track and trend information and produce routine quality monitoring reports and activities at the hospital.
Supervise and coordinate quality improvement efforts related to data collection and reporting, apply data to improvement activities, provide national comparative clinical benchmarks, and recommend areas or approaches for improvement.
Identify gaps or compliance issues; review, analyze, and summarize recommendations regarding utilization, quality, and severity measurements; and support initiatives by providing data to physicians, clinicians, and project participants.
Use internal and external software applications for data collection and analysis; accurately and promptly enter data into the program database; and ensure compliance with national registry requirements and protocols.
Monitor the timeliness, accuracy, availability, and security of information; support research initiatives; and analyze clinical and statistical information to identify quality issues and trends.
Collect and compare statistical data from hospital departments, reports, and patient medical records; analyze findings, make recommendations, and prepare meaningful reports for hospital committees.
Collaborate with interdisciplinary teams to define outcome parameters, design measurement tools, evaluate results, build relationships, and gain clinical support across divisions.
Serve as an educational resource when needed by developing educational materials and delivering presentations; help formulate action plans and communications related to findings.
Maintain professional knowledge through continuing education, literature, and seminars; represent the department and Cincinnati Children’s in professional associations and organizations; and apply acquired knowledge to the department.
Review patient records and interview hospital employees or medical staff when concerns arise about appropriateness of care or professional conduct; communicate with physicians when clinical review indicates alternatives to care.
Monitor cases for appropriateness of continued stay, level of care, services, and quality of care using approved screening criteria; refer cases for second-level review as needed; and defuse sensitive situations with healthcare professionals.
Follow up as needed to conduct or develop corrective or preventive practices and procedures.
Review patient medical records for treatment appropriateness, protocol compliance, core measures, and other review activities; facilitate compliance with protocols and documentation requirements; and conduct retrospective medical record reviews and abstraction for quality and utilization review cases.