[Hiring] RN-Peer Review Specialist @Reid Health

Role Description

The RN-Peer Review Specialist screens and assesses medical records for the quality and appropriateness of care. Case review is determined by established triggers and/or referrals from safety events, risk/legal, and other leaders. The RN-Peer Review Specialist will prepare cases in a standard format for formal review by the appropriate initial reviewer (section chiefs). The RN-Peer Review Specialist works closely with the Quality Manager and Director of Medical Staff Services to support the growth and development of Ongoing Professional Practice Evaluation (OPPE) metrics. The RN-Peer Review Specialist is a valued member of the Quality Department and collaborates closely with cross-functional partners in numerous departments across the organization.

Overview of Responsibilities

• Demonstrates knowledge of clinical documentation requirements with the ability to interpret and synthesize complex clinical concepts and apply knowledge of medical staff, including clinical practice guidelines and policies in the concurrent or retrospective review of patient medical records.
• Takes initiative to investigate and/or gather supporting documentation, clinical evidence or literature necessary to assess the clinical circumstances, event or outcome.
• Highlight the potentially relevant issues for the Provider who will perform the peer review.
• Provide data identifying the relevant practice patterns of the provider under review.
• Provide relevant benchmark comparisons of the provider under review.
• Identify instances of clinical performance and/or unprofessional conduct issues regarding non-provider staff.
• In partnership with the Quality Manager, Quality Director and assigned Executive Leadership and Chair of the Peer Review Committee, sustains and continually improves a reliable and efficient screening, assessment and reporting process.
• Flexibility schedules work time and availability to fulfill the program goals and meet the needs of the Peer Review Committee.
• Utilizes performance enhancing tools as part of the process improvements, problem analysis and measurement to lead projects.
• Facilitation of committee meetings including the creation of meeting agenda and documentation within the confidential Peer Review module of the event reporting system.
• Prepare monthly and quarterly reports and dashboards for Reid ambulatory and hospital oversight committees and governing bodies.
• Facilitate OPPE processes by aggregating and validating provider-level outcomes data, identifying performance trends, and preparing reports for medical staff committees.
• Facilitate FPPE reviews, ensuring timely assignment of cases, follow up on required proctoring or direct observation, and closure of evaluations with appropriate documentation.

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities that management deems necessary.

Qualifications

• Minimum of bachelor’s degree in health-related field or Bachelor’s Degree in other field.
• Minimum of 2 years acute care RN experience.
• Ability to interact, educate and positively influence all levels throughout the Healthcare system.
• Experience as leader in the Quality is preferred.

Licensure & Certification

• RN License in the state of Indiana.