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Job Summary:
This position is accountable for providing accurate, efficient and cost effective coordination of clinical review and performance improvement support services for the performance improvement and professional/peer review programs including ongoing and focused professional practice review for medical staff and allied health providers credentialed through the medical staff process. This position must demonstrate a commitment of quality service to our patients, the public, and our co-workers.
Essential Functions & Responsibilities:
Performs data and individual case analysis in accordance with established medical staff performance improvement/peer review guidelines or for cases referred to Medical Support Services from internal or external sources including, but not limited to, medical staff, Hospital Administration, Risk Management, Patient Relations, Quality Management, and Medical Staff/Hospital Committees.
Cases meeting criteria for physician level review are referred in accordance with medical staff guidelines with follow-up to assure timely completion of review and entry of peer conclusion(s) in the medical staff performance improvement/peer review database.
Performs analysis of aggregate data to identify practitioner-specific or other trends preparing narrative and/or graphic reports of findings.
Facilitates case presentations during meetings serving as the case content expert regarding indications for referral for peer review, case details, and patient care delivery timeline.
Serves as a resource to the medical staff on medical staff bylaws, policy and procedures relevant to medical staff quality/peer review.
Maintains practitioner-specific performance data and peer review files data in hard copy and/or electronic formats.
In collaboration with Credentialing Staff prepares practitioner-specific reports/profiles for the biennial appointment/re-privileging process and/or focused professional practice reports meeting with appropriate medical staff leaders to assure data is interpreted appropriately.
Provides input to the Director, Medical Support Services and Peer Review regarding opportunities to improve the medical staff quality/peer review program.
Performs other duties as assigned.
Qualifications:
Minimum of five (5) years recent healthcare work experience in following disciplines: Medical Staff Quality/Performance Improvement/Peer Review, Utilization/Case Management, Quality Management, or Risk Management.
Valid RN License from Virginia or reciprocal compact state preferred and will be considered in lieu of minimum experience.
BSN preferred.
Quality Management or Performance Improvement experience preferred.
Certified Professional Healthcare Quality (CPHQ) preferred.
Ability to assess and interpret clinical information. General working knowledge of ICD-10 coding preferred.
Working knowledge of Joint Commission, CMS, licensure and other regulatory requirements pertaining to peer review and quality management.
Requires basic computer skills including mouse navigation, Internet skills, knowledge of basic office software applications (MicroSoft preferred).
Prior work experience with MIDAS software and patient information systems preferred.
Ability to work autonomously with ability to prioritize and coordinate a variety of activities simultaneously.
Requires analytical skills and attention to detail.
Strong interpersonal skills with ability to communicate effectively, both orally and in writing.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
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