Clinical Review Specialist (St. Helena)

Adventist Health; St. Helena (CA); On-site; USD 89,603 - 134,404; Full time

Job summary

Adventist Health in Saint Helena, CA seeks a data quality professional to ensure accurate abstraction, validation, and submission of clinical data supporting CMS programs and safety initiatives.

The role applies clinical knowledge to identify trends, generate actionable insights for leaders, and maintain compliance with accreditation standards, while collaborating with registry vendors and the quality teams.

Qualifications

• Associate's or Technical Degree in Nursing, Healthcare Administration, or Health Information Management 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.

Responsibilities

• Performs concurrent and retrospective chart abstraction for peer review, quality, and regulatory reporting.
• Performs case abstraction for assigned registries and CMS measures; coordinates with registry vendors.
• Liaises between Quality Department, clinical stakeholders, and registry partners; provides feedback on documentation gaps or trends.
• Adheres to confidentiality requirements and regulatory standards.
• Monitors data trends and provides insights to quality and patient safety leaders.

Skills

Quality management

Data abstraction

Healthcare analytics

Peer review

Quality assurance

Hospital data reporting

Education

Associate's or Technical Degree in Nursing, Healthcare Administration, or Health Information Management

Certified Professional in Healthcare Quality (CPHQ)

Certified Professional in Patient Safety (CPPS)

Job description

Job Summary

Responsible for the collection, abstraction, validation, and submission of clinical data to support CMS quality programs, patient safety measures, national clinical registries, and/or peer review data. Ensures the accuracy and integrity of reported data, supports compliance with regulatory requirements, and contributes to performance improvement initiatives. Applies clinical knowledge to identify trends, monitor quality outcomes, and provide actionable feedback to leaders and clinicians. Supports confidentiality of peer review activities, prepares trended reports for leadership and medical staff committees, and assists in maintaining compliance with accreditation and regulatory standards. Is essential to achieving internal and external quality and patient safety targets.

Job 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 and Certifications

• Registered Nurse (RN) license or equivalent health background (Preferred)
• Certified Professional in Healthcare Quality (CPHQ) or Certified Professional in Patient Safety (CPPS) (Required)

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 maintains 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 Code 1157, PSWP, and organizational policies.
• Monitors 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.
• Performs other job-related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. All associates are required to receive all needed vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. For more information, visit https://adventisthealth.org/careers/everify/.

Job Information

• Job Identification: 63022
• Job Category: Specialist
• Posting Date: 2026‑07‑10
• Job Shift: Day Shift
• Locations: Saint Helena, CA, United States
• Assignment Category: Full‑time regular
• Pay Range: $89,603 to $134,404 (base; additional compensation available)
• Hiring Department: Quality Resources
• Shift Length: 8 Hours