Clinical Review Specialist (Lodi Memorial) at Adventist Health

Lodi, California, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Sep, 26

Salary

121909.0

Posted On

17 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Data Abstraction, Quality Management, Healthcare Analytics, Peer Review, Regulatory Compliance, CMS Quality Programs, Patient Safety, Chart Abstraction, Data Validation, Clinical Process Improvement, Medical Documentation, Healthcare Reporting

Industry

Hospitals and Health Care

Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Responsible for the collection, abstraction, validation, and submission of clinical data to support CMS quality programs, patient safety measures, national clinical registries and/or peer review data. Ensures the accuracy and integrity of reported data, supports compliance with regulatory requirements, and contributes to performance improvement initiatives. Applies clinical knowledge to identify trends, monitor quality outcomes, and provide actionable feedback to leaders and clinicians. Supports confidentiality of peer review activities, prepares trended reports for leadership and medical staff committees, and assists in maintaining compliance with accreditation and regulatory standard. Is essential to achieving internal and external quality and patient safety targets. Job Requirements: Education and Work Experience: * Associate's or Technical Degree in Nursing, Healthcare Administration, or Health Information Management or equivalent combination of education and experience: Required * Two years' of experience in quality management, data abstraction, or healthcare analytics: Required * Three years' of experience in peer review, abstraction, quality assurance, or hospital data reporting: Preferred Licenses/Certifications: * Registered Nurse (RN) license or equivalent health background: Preferred * Certified Professional in Healthcare Quality (CPHQ) or CPPS: Required Essential Functions: * Performs concurrent and retrospective chart abstraction for peer review, quality, and regulatory reporting using defined criteria. Ensures data accuracy and timeliness of submissions to internal and external databases. * Performs case abstraction for assigned registries and/ or CMS IOR and QOR measures (e.g., STS, CoC, NSQIP, or other specialty registries). Collaborates with outsourced registry vendors and maintain effective communication with system quality teams. Ensures timely data submission to meet internal and external reporting requirements. * Serves as a liaison between the Quality Department, clinical stakeholders, and registry partners. Provides feedback to physicians, nurses, and leaders on documentation gaps or trends impacting data accuracy. Supports initiatives to improve compliance with quality metrics. * Adheres to all confidentiality requirements under state and federal peer review protections. Ensures that data collection and storage comply with Evidence Code §1157, PSWP, and organizational policies. * Monitors data trends to identify opportunities for clinical process improvement. Provides reports and data insights to Quality and Patient Safety leaders. Supports performance improvement teams with accurate, validated data to guide interventions. * Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein. Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

Responsibilities

Responsible for collecting, validating, and submitting clinical data to support CMS quality programs and national clinical registries. The role involves monitoring data trends to provide actionable feedback for clinical process improvement and ensuring compliance with regulatory standards.