New

Clinical Review Specialist

Mass General Brigham Community Physicians
$63,648.00 - $90,750.40
remote work
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
May 29, 2026
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: 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. 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. Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.