Clinical Review Specialist (White Memorial)

About the role

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.

Responsibilities

• 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 Code1157, PSWP, and organizational policies.
• Maintains 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.

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

Qualifications

• 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 Code1157, PSWP, and organizational policies.
• Maintains 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.

Skills

• Strong clinical knowledge and understanding of healthcare regulations and standards.
• Excellent attention to detail and ability to manage multiple tasks simultaneously.
• Effective communication skills, both written and verbal.
• Proficiency in Microsoft Office Suite and familiarity with electronic health records (EHR) systems.

Benefits

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.

Pay

The estimated base pay for this position is $89,603 to $134,404. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Schedule

Hiring Department: Quality Resources Shift Length: 8 Hours