Clinical Review Specialist

Site: Mass General Brigham Community Physicians, Inc. 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 Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $63,648.00 - $92,570.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 6010 Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. 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.