• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). • Perform projects or duties as assigned as a Medical Review Specialist. • Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles. • Utilize electronic health information imaging and input medical review decisions by electronic database module. • Ensure departmental compliance with quality management system and ISO requirements.

Overview GENERAL SUMMARY Nationwide Search-Incumbent can reside anywhere in the United States Position – Disease Specific Care Stroke Field representative. The Disease Specific Care Field Representative applies sophisticated analysis skills and inductive reasoning skills to determine a health care organization's degree of compliance with applicable program standards. They must be able to employ advanced and sometimes nuanced communication skills to engage health care organization staff in interactive dialogues on a broad array of health care issues to assess compliance and to identify opportunities for improving compliance. Responsibilities - Conducts a thorough evaluation of assigned services and programs that meet DSC certification eligibility criteria. Plans, reviews and apportions review time so that all review requirements are addressed thoroughly per program. Reviews and evaluates pre-review information; researches, collects, organizes, and interprets a large volume of information from multiple sources. Interviews staff and patients to determine level of compliance with standards. Analyzes documents, such as performance data and clinical practice guidelines, to assess the level of compliance with The Joint Commission standards, evidence of performance improvement, and quality of care. - Using established review protocols: - Analyzes written self-descriptive program information. - Participates in and/or conducts all required conferences and interviews; analyzes all data submitted by the organization. - Documents all recommendations, providing adequate indication on non-compliance. Submits review findings in a complete, accurate, and timely manner to the Central Office. - Interprets and explains the intent of the standards to the organization’s personnel. Consults with staff during review re: non-compliance, opportunities for improvement, and remedial action required. Recommends publications and other resources that clarify standards and/or demonstrates compliance with standards. Qualifications Advanced Degree in Nursing or Licensure as a Physician required. Board Certification in Neurology required. You must hold a CPHQ certification (Certified Professional in Healthcare Quality) through National Association for Healthcare Quality (NAHQ) at time of hire or attain by December 31, 2028. Five years clinical experience with the care of Stroke patients required. Experience with a Joint Commission Comprehensive Stroke Center strongly preferred, however will consider those with Joint Commission Primary Stroke Center experience. All positions require 100% nationwide travel. We are currently looking for candidates who are available to work .48 FTE (2 weeks per month). Extensive nationwide travel required. We are currently hiring for our next orientation class to take place on June 8, 2026 Min USD $115,000.00/year Max USD $115,000.00/year

Site: Mass General Brigham Incorporated 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 Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits conducted at Mass General Brigham (MGB) facilities in accordance with the MGB Charge Audit Policy and established departmental policies/procedures. The Nurse Reviewer plays an important role in appealing challenges to charging policy and practice. The increased use of pre- and post-payer audits impacts MGB net revenue, to which the incumbent responds. Essential Functions -Coordinates the scheduling of audits with external third-party audit representatives/payors to initiate the audit process. -Prepares detailed packages for cases selected by audit representatives, including necessary documents needed to initiate the audit process. -Prepares audit responses and appeals for complex charge and forensic audits. -Documents, summarizes, and defends audit findings in a clear, concise, and effective manner to preserve MGB appeal rights. -Conducts post-audit research to support and defend cited charges by obtaining additional documentation. -Updates internal systems used for tracking and reporting findings, including but not limited to patient accounting systems, spreadsheets, and databases, to facilitate monthly management reporting. -Provides subject matter knowledge on various billing, coding, and clinical topics to the audit representatives and other key customers as needed. Qualifications - Bachelor's Degree in Nursing required - Registered Nurse [RN - MA State License] - required - 3+ years of experience in clinical nursing required - 2+ years of experience in a quality assurance or clinical review role required Skill for Success - Strong analytical skills with the ability to interpret clinical data and identify trends. - Excellent communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams. - Proficient in electronic health record (EHR) systems and clinical documentation tools. - Strong organizational skills and attention to detail. - Ability to provide constructive feedback and facilitate training for nursing staff. Working schedule: - Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working station Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $79,560.00 - $115,720.80/Annual Grade 7 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: 0100 Mass General Brigham Incorporated 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.

Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark’s comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources. Combined with evidence-based health interventions and a hybrid in-person + virtual care model, Daymark is improving the overall cancer experience for patients, providers, and health plans – and setting a new standard in cancer care. Daymark’s groundbreaking approach is led by CEO Dr. Justin Bekelman, a pioneer in transforming cancer care, alongside some of the nation’s foremost leaders in oncology and value-based care. Daymark Health is backed by Maverick Ventures, Yosemite, Oncology Ventures, Healthier Capital, Blue Venture Fund, and Healthcare Foundry. Be cautious of recruitment fraud, and always confirm that communications are coming from an official Daymark Health email. As a Per Diem Chart Reviewer at Daymark, you will be a key member of the Enrollment and Care Teams, supporting accurate program eligibility determinations for patients. You will review medical records, apply established clinical criteria, and ensure documentation supports eligibility for Daymark programs. Your role is essential in maintaining the integrity of our care delivery and supporting patients. WHAT YOU'LL DO In this role, you will conduct thorough reviews of medical records to support program eligibility determinations. On a day-to-day basis, this may include: - Chart Review: Conduct retrospective and concurrent reviews of inpatient, outpatient, and ancillary medical records to assess whether clinical documentation supports eligibility for Daymark Health's programs. - Criteria Application: Apply established clinical criteria and program-specific guidelines to evaluate medical necessity and eligibility determinations. - Clinical Documentation: Accurately abstract and document relevant clinical findings, diagnoses, procedures, and treatment history from the medical record. - Escalation & Collaboration: Identify documentation gaps or inconsistencies and escalate cases requiring physician or supervisor review as appropriate. - Compliance: Maintain strict confidentiality of all patient health information in accordance with HIPAA regulations and Daymark's policies, procedures, and documentation standards. - Quality Assurance: Participate in audits, quality reviews, and process improvement initiatives as requested, and stay current on program eligibility criteria and relevant regulatory updates. What We Are Looking For - Experience: An active, unrestricted Registered Nurse (RN) license in good standing is required. A minimum of 5 years of Oncology nursing experience required, with experience in case management strongly preferred. - Clinical Knowledge: Working knowledge of medical terminology, and clinical documentation standards. - Comfort with Technology: Proficiency with electronic health record (EHR) systems and comfort with tools such as Google Suite, Zoom, and Slack. - Analytical Skills: Strong critical thinking and attention to detail, with the ability to review and interpret complex clinical documentation independently. - Patient-Centric Approach: A deep commitment to Daymark's mission to support cancer patients with dignity & compassion. - Organizational Skills: Ability to manage multiple reviews simultaneously, meet established turnaround times, and maintain meticulous documentation. - Adaptability: Comfortable working independently in a dynamic environment with minimal supervision Additional Information This is a per diem, remote role. Availability of a minimum of 10 hours per week is required. Hours and schedule will vary based on organizational need, but typically range 10-20 hours per week. 2-3 hours of availability daily is strongly preferred over fewer, longer time periods. Compensation will range from $40 to $55 per hour, depending on a candidate's location and experience. Per diem employees are not eligible for benefits.