RN Peer Review Coordinator

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Other information:

Job Summary
The Peer Review Coordinator assists with activities of the CPE (Committee for Professional Enhancement) for SVH, CVH and SRC combined and its processes. Duties include performing chart reviews/audits to determine areas for improvement, identifying quality issues, and determining compliance with quality and regulatory initiatives. Using the Midas quality system, prepares abstracts for provider review and coordination of the full case review process which is included in the SRH MS Ongoing Professional Performance Evaluation (OPPE) process. The Peer Review Coordinator may be required to assist and direct the functions of the CPE. Drafts provider correspondence, maintains records of same, and assists with preparing the agendas and meeting minutes. Through the Midas quality reporting system, the Peer Review Coordinator also manages the activities for Opportunities for Improvement (OFI) and trending program which is based upon provider directed indices. The responsibilities include the correspondence to providers and management of data used for the medical staff OPPE process. The OPPE data is aggregated, analyzed, and reported to the medical staff division chiefs, the medical staff credentialing committee, Medical Executive Committee (MEC), and the Board of Commissioners as required by DNV. The Peer Review Coordinator also reviews and screens deaths to determine opportunities for improvements in health care delivery. Data reports are documented in Midas identifying potential areas for improvement and summaries of deaths are submitted to the Chief Medical Officer-Vice President of Medical Staff, Vice President of Quality Management, and Vice President of Population Health for review. Through the Midas quality incident reporting system, the Peer Review Coordinator reviews safety events submitted to the facility which reference medical care provided by MS and routes/intervenes as appropriate with actions as noted above, case review, OFIs/rule break, RCA, etc. Peer Review Coordinator may be asked to be an active member of the Nursing Case Review Committee (Nursing Peer Review). This position is expected to work on-site at locations in Mount Vernon and Arlington.

Essential Functions
Conducts case reviews and CPE activities in a timely manner. Assists with managing the activities of the CPE covering over 500 medical staff members. Develops correspondence with providers for the CPE and Rule Breaks and collects data for all activities. Assists with managing committee functioning and documentation. Acts as clinical resource for the review of safety events pertinent to medical care and other clinical situations. Utilizes expert clinical knowledge of medical disease processes and medical/procedural terminology in all aspects of/and multiple specialties of healthcare. Complete all mandatory learning requirements in a timely manner. Maintain current licensure and/or certification as required. Attend and actively participate in all department, team and/or committee meetings. Comply with all Skagit Regional Health, department and location specific policies and procedures. Perform other duties as assigned by Supervisor or designee.

Education
Bachelor’s degree in nursing required. Masters in nursing or other healthcare field preferred.

Experience/Training
Minimum 10 years of recent nursing experience in acute care settings required. Additional experience in clinic settings or outpatient settings beneficial. Experience in quality management and/or case management in a healthcare environment, possessing an understanding of quality improvement principles, theories, and tools. Peer review experience and/or medical record clinical review experience including data abstraction and analysis. Experience working collaboratively. Experience with performance improvement tools, methodologies, measurement, data analysis and a statistical background preferred. Must be able to achieve working knowledge of and apply accreditation and regulatory requirements to related work.

License/Certifications
Current Washington State RN license required. CPHQ Preferred.

Other Skills
Proficient in EPIC, Midas, Excel and Word. Understands Quality and Medical Staff database electronic systems. Demonstrated verbal and written communication skills and collaborative project management, excellent interpersonal skills. Demonstrates individual and group teaching skills. Able to perform medical record audits and compile information into aggregate information. Clinical database entry and management skills preferred. Ability to apply independent critical thinking and problem-solving skills. Effective verbal and written communication skills. Ability to organize and prioritize workload to meet deadlines and demands of the Medical Staff, CPE, medical staff services, and administration. Must possess ability to handle a variety of problems and situations, often of extreme urgent and confidential nature. Must be able to work independently and use independent judgment to perform a wide variety of tasks in a professional way.

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.