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Peer Review & Clinical Improvement Coordinator

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Job Details
Job Order Number
JC140762051
Company Name
Stormont-Vail HealthCare
Physical Address

Topeka, KS 66612
Job Description

Summary:

The Peer Review and Clinical Improvement Coordinator supports the effective operation of the organization’s Provider peer review functions, including management and oversight of the HSD Medical Staff & MSD Medical Staff peer review processes across the enterprise.

Essential Duties and Responsibilities include the following.

+ Direct management of the provider peer review workflow from acceptance of cases for peer review, facilitation of initial screening if applicable, preparation of peer review materials, documentation of peer review results, production of reports and maintenance of peer review databases.

+ Manage, monitor performance and provide oversight to peer review processes across the organization to assure process effectiveness, timeliness, consistency and compliance with organizational policy.

+ Educate participants in and facilitate the functions of the Medical Staff (hospital and clinics) peer review committees to achieve the purposes of the peer review process; Serve as a consultant, as needed, to nursing and other organizational peer review committees.

+ Manage day-to-day regulatory reports and other confidential communications related to findings of peer review committees in accord with organizational policy and medical staff bylaws, rules and regulations;

+ Perform chart reviews/audits/investigations/assessments to determine areas for improvement, identification of quality issues, and determining compliance with quality and regulatory initiatives as part of the peer review process

+ Management of data for provider and clinician performance profiles, department/service line profiles and ad hoc data queries;

+ Participate in performance improvement and quality evaluation projects supporting clinical improvement opportunities;

+ Provide provider and organizational education regarding the peer review process;

+ Support organizational learning and improvement through appropriate identification of lessons learned, best practices and practice improvement projects that impact provider and clinician practice;

+ Support peer review committees, reviewers and clinicians in the effective application of principles related to Just Culture, Patient Safety, and Risk Management in the evaluation of peer review matters.

+ Serve as subject matter expert consultant to provide guidance to peer review processes for non-provider specialties to assure consistent compliance with regulatory, accreditation and clinical improvement processes.

+ Support and coordinate Medical Staff and Hospital Peer Review Committee meetings, documentation and activities across defined departments, service lines and entities

+ Collaborate closely with Medical Staff, Medical Staff Services, Risk Management and Hospital/Clinic leadership on providing accurate clinical summaries, data trending, reports and analysis

+ Coordinate and communicate with physicians, providers and other clinical professionals regarding screening, scoring and presentation of cases for peer review.

+ Coordinate follow up, planning, referral and improvement processes resulting from peer review;

+ Manage referrals from patient complaints, incidents, committees and other sources that identify matters meeting criteria for formal peer review;

+ Provide data abstraction, analysis and reporting of trends related to defined outcomes. Compiles, analyzes and presents clinical improvement information to appropriate organizational and medical staff committees.

+ Designs tools, templates, standard work documentation and materials to assure consistent and appropriate management of peer review activities;

+ This position may provide supervision, either directly or indirectly, to those providing peer review related services, case reviewers, analysts or others;

+ Maintain knowledge of evidence-based, CMS and tJC clinical metrics and, as needed, serve as a subject matter expert to support development of effective clinical performance benchmarks, peer review triggers and clinical performance monitoring;

+ Investigate, research and gather information necessary to support effective reviewer and committee interpretation, evaluation and intervention related to potential opportunities for improvement related to provider and clinician improvement.

Required Education/Experience :

+ BSN or Licensed RN with at least 5 years of experience in a complex clinical setting or other certified clinical role with at least 10 years of experience in a complex clinical setting

+ Minimum of three (3) years clinical experience in an acute hospital, multispecialty clinic, health insurer or other diverse clinical environment with exposure to multiple specialty areas.

+ Experience in a self-directed role and/or management

+ Experience in interacting closely with clinical providers, ancillary and other clinicians

+ Excellent communication and facilitation skills

+ Computer proficiency in EHR and in use of tools for data review and management

+ Ability to communicate effectively using verbal, non-verbal and written methods

+ Experience in management, analysis and presentation of qualitative and quantitative data and information with an ability to customize information to varied audiences from Governing Body to frontline clinicians.

Preferred Education/Experience:

+ Five years of experience in quality review, peer review, utilization review or other critical evaluation/audit role which requires evaluation of clinical practice

+ CPHRM, CPHQ or other clinical quality or clinical reviewer certification

+ Experience interpreting policies, data standards, rules and regulations and accreditation standards in order to support effective evaluation of practice2-5 years of experience in data harvesting, quantitative and qualitative reporting and analysis of information

+ Advanced Microsoft Excel, PowerPoint and Publisher skills

Language & Communication Skills:

Able to manage all confidential matters. Ability to read, analyze, and interpret clinical reports and medical terminology, audits, legal documents, clinical periodicals, professional journals, technical procedures, or governmental regulations. Ability to write and maintain business reports, business correspondence, policy and procedure manuals with competency in spelling, punctuation and grammar. Ability to organize and maintain complex filing and data systems. Ability to learn and apply new terminology, clinical practice requirements and clinical measurement terminology to support evolving peer review and clinical practice assessment. Able to adapt communication style, language and approach to meet the needs of various providers, audiences and customer groups.

Mathematical Skills:

Ability to apply concepts and operations to the development of statistical and

analytical reports. Able to perform basic quantitative and qualitative computations and calculations to support effective analysis, evaluation, prioritization and management of clinical performance reviews

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to

apply common sense understanding to carry out instructions furnished in


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