Quality Clinical Reviewer - UI Health

Quality Clinical Reviewer - UI Health

Location:

Chicago, IL USA

Requisition ID: 1039748

FTE: 1

Work Schedule: 8:00AM - 4:30PM

Shift: Days

# of Positions: 1

Workplace Type:  Hybrid  

Salary Range (commensurate with experience): $76,148.80 - 154,232.00 / Annual Salary
 

About the University of Illinois Hospital & Health Sciences System (UI Health)

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois Chicago (UIC), UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

This position is intended to be eligible for benefits. This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

 

The Clinical Quality Reviewer plays a key role in advancing quality, safety, and performance improvement initiatives within UI Health. This position conducts detailed clinical record reviews, validates quality and performance metrics, and supports regulatory, accreditation, quality, and patient safety activities. The reviewer works collaboratively with physicians, nurses, Clinical Documentation Improvement (CDI), HIM coders, quality leaders, and operational teams to ensure accurate measurement, reporting, and improvement of clinical quality and safety.

Duties & Responsibilities:

• Conduct comprehensive retrospective and concurrent medical record reviews to assess quality of care, clinical outcomes, documentation accuracy, and adherence to evidence-based guidelines and institutional policies.
• Collaborate closely with Clinical Documentation Improvement and Coding teams to ensure clinical documentation accurately reflects patient acuity, severity of illness, risk of mortality, and quality indicators.
• Conduct thorough clinical validation of PSIs, HACs, eCQMs, and other quality measures, including identification of cases where documentation or coding discrepancies may require recoding.
• Close the loop on cases flagged for potential rebilling by ensuring that corrected documentation and coding are accurately submitted, collaborating with CDI, Coding, and Finance team.
• Verify that any changes resulting from recoding are reflected in internal and external reporting
• Participate in interdisciplinary discussions related to documentation standards, abstraction logic, measure definitions, and data integrity.
• Serve as a trusted clinical partner to physicians, PAs, APRNs, and other providers to clarify documentation, ensure accurate clinical coding, and support compliance with quality and regulatory measures.
• Identify documentation gaps, inconsistencies, or opportunities for clarification that impact quality metrics, performance reporting, and outcomes measurement.
• Develop and deliver targeted training sessions, workshops, or one-on-one education to providers and interdisciplinary staff to improve documentation quality and optimize patient safety outcomes.
• Participate in root cause analyses (RCA), failure mode and effects analyses (FMEA), Critical Incident Debriefs (CID) and performance improvement initiatives targeting patient safety, quality outcomes, and public reporting performance.
• Ensure review of activities aligned with institutional policies and external regulatory and accreditation requirements.
• Provide feedback to clinicians and operational teams in a professional, collaborative, and educational manner.
• Prepare clear, accurate, and actionable summaries of review findings for quality leadership, clinical departments, and committees.
• Maintain confidentiality and comply with all policies related to peer review, protected quality activities, and data security.
• Participate in quality committees, case review conferences, and performance improvement meetings.
• Perform other related duties and participate in special projects as assigned.

 

 

Minimum Qualifications Required: 

1. Bachelor's degree as required by the position to be filled in the area of specialization inherent in the position may be required.
2. Current/Valid certification as a Certified Professional in Healthcare Quality (CPHQ) or other closely related certifications by an approved certifying board as defined by the employing institution.
3. Four (4) years (48 months) of Quality Improvement (QI) work experience in a clinical or healthcare related field/setting performing duties comparable to the Senior Quality Specialist level of this series.

**Applicants possessing a Master's degree, in a closely related field, meet the requirements for #1 above.

Preferred Qualifications:

• Familiarity with CMS quality programs, Joint Commission standards, and publicly reported measures
• Training or experience with quality improvement methodologies (Lean, Six Sigma, PDSA).
• CPHQ, CCDS, CCS, CPPS, or related certification, or willingness to obtain within a defined timeframe
• Strong interpersonal and communication skills; ability to lead and manage change. Is self-directed and works well in groups/teams exercising sound clinical judgment
• Active clinical licensure 
• Bachelor’s degree required, advanced degree preferred
• Minimum of 5 years of clinical experience in an acute care or AMC setting
• Working knowledge of clinical documentation, quality metrics, and patient safety principles
• Advanced knowledge of AHRQ specifications, PSIs, HACs, and eCQM methodologies, and regulatory reporting requirements are strongly preferred
• Advanced proficiency in the electronic health record (Epic), including clinical documentation review, chart navigation, reporting tools, and use of data to support quality validation, eCQM review, and regulatory reporting. 
• Ability to leverage Epic and Solventum data to validate PSIs, HACs, eCQMs, and other CMS metrics.