Clinical Review Specialist
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AI Summary
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.
Job Summary
The Clinical Review Specialist will assess the medical necessity and appropriateness of healthcare services.Primary 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.
Qualifications
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.
Additional Job Details (if applicable)
Schedule and Work Model:
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.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$63,648.00 - $90,750.40/Annual
Grade
6
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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