Peer Review Specialist

Provides leadership and applies clinical knowledge to ensure the medical staff peer review process is effective in evaluating issues related to professional practice. Develops accurate clinical case summaries, data trending, reports and analysis for medical staff leadership and peer review committee consistent with established guidelines. Manages the physician peer review clinical process including tracking committee recommendations and follow-up actions for timeliness of response. Assists medical staff leadership with physician performance initiatives and coordinates clinical and non-clinical performance improvement in compliance with organizational goals and regulatory standards.

POSITION SUMMARY

Provides leadership and applies clinical knowledge to ensure the medical staff peer review process is effective in evaluating issues related to professional practice. Develops accurate clinical case summaries, data trending, reports and analysis for medical staff leadership and peer review committee consistent with established guidelines. Manages the physician peer review clinical process including tracking committee recommendations and follow-up actions for timeliness of response. Assists medical staff leadership with physician performance initiatives and coordinates clinical and non-clinical performance improvement in compliance with organizational goals and regulatory standards.

PRIMARY RESPONSIBILITIES

• Works in conjunction with ministry leadership and medical staff leadership to coordinate the physician peer review process which entails review, analysis, and summation of the medical records. Applies clinical knowledge to screening criteria to identify cases meeting criteria and those requiring further analysis. Coordinates and communicates with leadership and peer review committee membership to ensure consistent screening and scoring presentation of select cases for peer review.
• Attends physician peer review meetings and serves as a liaison between various committees to facilitate communication and referral of cases for further physician review and reports results back to referring committee. Provides support and assistance to other hospital departments as necessary to facilitate the physician peer review process by coordinating cases referred for physician peer review.
• Oversees and ensures physician peer review data is entered into the credentialing database in a timely and accurate manner. Coordinates with CMO and appropriate staff to generate appropriate reports for designated medical staff, regional and hospital committees and leadership.
• Manages information and supports medical staff leadership to ensure accountability for follow-up responsibilities. Documents all steps of medical staff peer review committee management. Ensures compliance with ongoing process for peer review related minutes, documents, policies and files to mitigate legal and regulatory risk.
• Creates charts and graphs to facilitate the communication of data and trends. Designs and implements a system for planning, organizing and controlling workflow and reporting related to physician dashboards and peer review.
• Coordinates multidisciplinary approach to clinical concerns by working closely with nursing and ancillary departments.
• Assists with preparation of quarterly peer review reports that are reported up to appropriate system committees.
• Maintains knowledge of the hospital Medical Staff Bylaws, Rules and Regulations and associated policies. Maintains professional knowledge of peer review requirements of Joint Commission and other regulatory agencies, along with best practices for peer review and strategies for successful outcome-based quality initiatives internally and externally. Meets with external agencies during investigations and complaints, as needed.
• Supports the measurement and monitoring of quality indicators and progress towards metrics primarily at the physician level and at department, hospital and system levels as indicated.
• Performs other duties as assigned.

EDUCATION

• Bachelor's degree in Nursing from an accredited school of professional nursing

EXPERIENCE

• Three years’ clinical experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.