Quality Outcomes Coordinator

Overview

This professional nursing role is responsible for the coordination, implementation and maintenance of an effective Medical Staff peer review process and for supporting the Risk Management program, consistent with the guidelines set forth by the Medical Staff, the Quality Services Department, and the overall Hospital Performance Improvement goals. This position provides support to the AHMC-ARMC Medical Staff and Risk Management in the monitoring and evaluation of the appropriateness and the quality of patient care provided by those with delineated clinical privileges. The Clinical Outcome Review Coordinator works collaboratively with the Manager of Clinical Risk and Patient Safety, other members of the Quality Services Department, the Medical Staff Services Department, and the Medical Staff leaders to review and analyze incoming unusual occurrence reports and to implement, evaluate and refine a standardized Physician Performance and Peer Review Program that is educational, timely, standardized, defensible, ongoing and instrumental in assessing and improving the quality of care at AHMC Anaheim Regional Medical Center. 

The Clinical Outcome Review Coordinator ensures that approved concurrent or criteria-based functions of designated patient groups occur timely and according to established departmental and regulatory/accreditation guidelines.  He or she recognizes variations from criteria and communicates with a variety of clinical disciplines and/or physician reviewers to clarify/justify the variation.  He or she prepares and communicates findings from focused and ongoing reviews to the appropriate Medical Staff Department Chairpersons and the Medical Staff Department Peer Review Committees.

This position requires the full understanding and active participation in fulfilling the mission of AHMC- Anaheim Regional Medical Center and AHMC Inc. It is expected that the employee demonstrate behavior consistent with the core values of AHMC-ARMC and AHMC Inc. The employee shall support AHMC- Anaheim Regional Medical Center’s strategic plan and goals and direction of the performance improvement plan.  The employee will also be expected to support all organizational expectations including, but not limited to:  Customer Service, Patients’ Rights, Patient Safety, Confidentiality of Information, Environment of Care and AHMC Inc initiatives.

Responsibilities

A. Consistently applies infection control policies/practices.

B. Meets population/age specific competencies per unit specific addendum.

C. Attends mandatory inservices/educational/training activities.

D. Department specific performance improvement project.

E. Assists the Medical Staff department leadership in determining criteria for conducting ongoing professional practice evaluation (OPPE), triggers indicating the need for focused professional practice evaluation (FPPE), and ongoing clinical monitors.

F. Assists in the review and analysis of incoming unusual occurrence reports for regulatory, patient safety and peer review concerns.

G. Conducts timely, accurate concurrent and retrospective clinical case reviews by abstracting clinical data from medical records, based on predetermined screening criteria and case referrals from Risk Management and external organization inquiries (i.e., regulatory and/or accrediting bodies, insurance companies, etc).

H. Organizes, maintains and validates peer review data to ensure data completeness, validity and integrity on an ongoing basis to support medical staff performance improvement and patient safety organizational activities.

I. Participates in medical staff peer review committees in collaboration with the Medical Staff Department Chairperson.

J. Participates in the review and analysis of incoming Risk Management occurrence reports, especially those related to physician practice.

K. Ensures proper function of the Risk Management and Medical Staff Peer Review process.

L. Maintains and applies knowledge of accreditation and licensing standards pertinent to improving organizational performance.

Additional job responsibilities:  As assigned by the Executive Director, Quality Services.

Qualifications

• BA, BSN, or BS or Associates Degree preferred.
• Current CA RN or LVN license
• Three years experience in Quality Services, Peer Review, Performance Improvement, Risk Management or Case Management preferred.
• Experiential focus on monitoring and evaluation of medical staff processes in order to meet state, federal and other regulatory agency requirements.
• Comprehensive knowledge of The Joint Commission standards and Title 22 requirements.
• Ability to perform technical analysis of patient records, abstract pertinent information and prepare and present clinical information in such a manner as to highlight statistical significance and relevance.
• Ability to address multiple tasks that frequently have short timelines.
• Ability to work independently.
• Ability to maintain current and accurate databases and files.
• Ability to communicate effectively in both the written and verbal format.
• Basic typing and computer proficiency in Microsoft Office and MicroMed applications.
• Proficiency in medical terminology.