Nurse Reviewer Maternal Health - 259518

Job Title: Clinical Reviewer – Nurse (RN) Maternal Health

Position Type: Full-Time, 1-Year Contract (40 Hours/Week)

Schedule: Monday – Friday, 40 hours per week (Flexible shifts between 7:30 AM – 5:30 PM)

Job Overview

We are seeking a detail-oriented Registered Nurse (RN) with a strong clinical background and exceptional written communication skills to join our Maternal Child Health Programs team as a Clinical Reviewer .

In this role, you will perform complex clinical record reviews for high-impact healthcare quality and compliance initiatives. You will synthesize medical records, interview transcripts, and clinical data to produce objective, high-quality written summaries for review boards, New York State (NYS) regulatory agencies, and the Centers for Medicare & Medicaid Services (CMS).

Key Responsibilities & Core Projects

1. Maternal Mortality Project

• Conduct comprehensive clinical evaluations of cases involving maternal mortality tracked by CMS and NYS.
• Review all clinical documentation, medical records, and phone interview transcripts (conducted by staff) with patients' families and loved ones.
• Prepare clear, objective, and detailed written clinical summaries for evaluation by the state review board.
• Manage an annual volume of approximately 50 cases per year, ensuring thorough and complete evaluations.

2. Office-Based Surgical Incident Reviews

• Review case documentation involving unexpected office-based surgical incidents across various outpatient settings.
• Perform high-priority, timely case reviews and draft clinical findings to submit directly to the Department of Health (DOH).

3. Additional Duties

• Analyze data and medical records to evaluate compliance with relevant healthcare regulations and clinical guidelines.
• Draft, edit, and finalize objective clinical review reports using standardized tools, shared platforms, and internal databases.
• Attend regular team meetings and collaborative reviews to ensure project alignment and quality standards.

Qualifications & Requirements

Education & Credentials

• Licensure: Active Registered Professional Nurse (RN) license in New York State (NYS) in good standing.
• Education: Bachelor’s Degree in Nursing (BSN) OR graduate of an approved Registered Professional Nurse training program.

Experience & Clinical Background

• Clinical Experience: Strong clinical background in Maternal Health, NICU, ICU, Emergency Medicine, or Inpatient Generalist care .
• Chart Review Experience: Preferred experience in chart review, medical record evaluation, Quality Improvement (QI), or Utilization Review (UR).
• Objective Analysis: Demonstrated ability to examine complex facts objectively, maintain professional objectivity, and navigate emotionally sensitive cases.

Skills & Competencies

• Communication Skills: Excellent written communication and report-writing skills (ability to translate complex medical data into clear, concise written summaries for review boards).
• Technical Skills: Proficient in standard office software and tools (Microsoft Word, Excel, Teams, and specialized databases).
• Self-Direction: Strong organizational skills and the ability to work independently while balancing multiple case reviews.