Clinical Review Specialist

4 weeks ago Be among the first 25 applicants

Location: Optalis Healthcare – 25500 Meadowbrook Rd. Ste 270, Novi, MI 48375

Optalis Healthcare is dedicated to delivering high-quality, patient-centered care and supporting clinical excellence across all our communities. We are seeking a knowledgeable and detail-oriented Clinical Review Specialist to join our corporate team. This role plays a critical part in ensuring accurate clinical documentation, compliance with regulatory standards, and optimized reimbursement processes.

The Clinical Review Specialist is responsible for reviewing clinical documentation to ensure accuracy, completeness, and compliance with regulatory and payer requirements. This individual will work closely with facility teams, clinical leaders, and reimbursement staff to support quality outcomes and appropriate reimbursement.

• Review and evaluate clinical documentation for accuracy, completeness, and compliance with regulatory and payer guidelines.
• Collaborate with facility clinical teams to clarify and improve documentation as needed.
• Identify trends, gaps, and opportunities for improvement in documentation and coding practices.
• Assist in the development and implementation of training and education programs to support clinical staff.
• Monitor changes in regulations and payer requirements to ensure ongoing compliance.
• Partner with reimbursement and operational teams to support accurate and timely billing processes.
• Maintain confidentiality and adhere to all HIPAA and compliance standards.
• Provide clear and concise feedback to facility teams and leadership.

• Experience with clinical documentation review, utilization review, or reimbursement preferred.
• Strong knowledge of regulatory requirements, MDS, and payer guidelines.
• Excellent analytical, critical thinking, and communication skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).
• Highly organized and detail-oriented with the ability to manage multiple priorities.
• Ability to work collaboratively with facility teams and corporate departments.

• Mission-driven organization focused on clinical excellence and quality outcomes.
• Supportive, collaborative corporate team environment.
• Opportunities for growth and professional development.
• Competitive compensation and comprehensive benefits package.

Entry level

Full-time

Health Care Provider

Hospitals and Health Care

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