[Hiring] Medical Staff Peer Review & Facility Enrollment Coordinator @Adena Health

Role Description

In the role of Medical Staff Peer Review Coordinator and Facility Enrollment, this individual is responsible for coordinating and facilitating the medical and allied health staff peer review process to ensure quality, safety, and adherence to regulatory standards. This role involves organizing review activities, maintaining documentation, and supporting medical staff in continuous quality improvement efforts.

• Manage and coordinate the FPPE (Focused Professional Practice Evaluation) and OPPE (Ongoing Professional Practice Evaluation) processes for both physician and advance practice professionals.
• Facilitate the evaluation of practitioner competence and maintain accurate documentation of professional practice assessments.
• As Facility Enrollment Specialist, manage the enrollment processes for the hospital’s and facilities within the organization, ensuring proper enrollment with insurance payers, government programs, and other relevant entities.

Qualifications

• Bachelor’s degree in healthcare administration, nursing, or related field.
• Preferred: Certified Peer Reviewer.
• 5 years in acute hospital setting.
• Preferred: 2-3 years of Peer Review, Quality, Patient Safety, and Facility Enrollment experience.

Requirements

• Knowledge of medical staff processes, healthcare quality assurance, and regulatory standards.
• Strong organizational and communication skills.
• Ability to handle sensitive information with discretion.
• Experience with healthcare documentation and data management systems.
• Knowledge of accreditation standards (e.g., The Joint Commission), regulatory requirements, and healthcare quality metrics.
• Attention to detail and ability to manage multiple priorities.
• Familiarity with healthcare data management systems and credentialing software.
• Excellent interpersonal and collaboration skills.
• Ability to interpret and apply complex regulatory standards.
• Discretion and confidentiality in handling sensitive information.

Job Specific Essential Functions

• Peer Review:
  • Coordinate the peer review process for medical staff, including scheduling, communication, and documentation.
  • Collect, organize, and maintain peer review data, reports, and related records in compliance with hospital policies and regulatory requirements.
  • Assist medical staff and reviewers with the review process, ensuring timely and thorough assessments.
  • Facilitate communication among medical staff, hospital administration, and review committees.
  • Prepare summaries, reports, and follow-up documentation related to peer review activities.
• FPPE/OPPE:
  • Analyze and compare initial privilege requests to clinical benchmark criteria.
  • Oversee the implementation and ongoing administration of FPPE and OPPE programs.
  • Coordinate the collection, review, and documentation of practitioner performance data.
  • Ensure timely completion of FPPE when practitioners are initially credentialed or after renewal.
  • Monitor and facilitate OPPE activities for ongoing performance evaluation.
  • Gather data from various sources such as peer reviews, patient outcomes, incident reports, and other quality metrics.
  • Analyze practitioner performance data to identify trends and areas for improvement.
  • Prepare reports for medical staff leadership and hospital administration.
  • Act as a liaison between medical staff, quality improvement, credentialing, and administrative departments.
  • Educate physicians and providers on FPPE and OPPE processes and requirements.
  • Facilitate communication regarding performance concerns and improvement plans.
  • Ensure confidentiality and integrity of peer review information.
  • Support compliance with accreditation standards and hospital policies regarding quality assurance and peer review.
  • Assist in the development and implementation of policies and procedures related to peer review.
  • Provide education and support to medical staff regarding peer review processes and expectations.
  • Stay current with relevant regulations, standards, and best practices related to peer review and quality assurance.
  • Ensure all FPPE and OPPE activities align with Joint Commission standards, state regulations, and hospital policies.
  • Maintain documentation to support accreditation and licensing audits.
• Facility Enrollment:
  • Prepare and submit enrollment applications.
  • Maintain accurate entity records.
  • Track application statuses and resolve any issues that may arise during the enrollment process.
  • Ensure compliance with all relevant regulations and payer requirements.
  • Assist with periodic audits of provider files and ongoing compliance requirements for delegated credentialing.
  • Administrator and Primary Contact with payers and entities related to facility enrollment (e.g., UHC portal, IHD-Medicaid).
• Software:
  • Administrator, SME, and Liaison with Symplr- DataVision and StatIT, Cactus- Peer Review or other software identified for Peer Review, FPPE, or OPPE in the future.