Clinical Review Specialist in Somerville, Massachusetts

Clinical Review Specialist

The Clinical Review Specialist will assess the medical necessity and appropriateness of healthcare services. Primary responsibilities include reviewing medical records and treatment plans to ensure they align with established guidelines and standards, participating in department quality improvement initiatives, reviewing and applying analytical skills to designated patient population medical record documentation to assess the level of documentation accuracy and completeness, and providing clinician-specific education regarding quality, outcomes improvement, documentation standards, and actions to improve clinical processes.

Qualifications include a Bachelor's Degree in Nursing (BSN) or related field of study required, 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, and Coding Credential (CRC, CPC or CCS) preferred.

Additional knowledge, skills, and abilities include reviewing medical records and treatment plans to ensure that they align with established guidelines and standards, participating in department quality improvement initiatives, reviewing and applying analytical skills to designated patient population medical record documentation to assess the level of documentation accuracy and completeness, and providing clinician-specific education regarding quality, outcomes improvement, documentation standards, and actions to improve clinical processes.

Additional job details include 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.