RN Peer Review Coordinator (Full Time), St. Vincent

Company :

Job Description : 

St. Vincent Hospital

St. Vincent Hospital is a Magnet®-designated hospital for excellence in nursing, serving the people in the Lake Erie region since 1875 with a quality of care and service second to none!  

Allegheny Health Network

At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities.  AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees.

GENERAL OVERVIEW:

The Peer Review Coordinator will support the hospital's medical staff peer review function in compliance with legal and regulatory standards, CMS Conditions of Participation and the Medical Staff Bylaws. The Peer Review Coordinator will oversee the day to day peer review process including acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. This person will remain current and insure compliance with peer review state statues, federal requirements, medical staff bylaws, internal policies and procedures, and Joint Commission regulations. They will be responsible for the education of the peer review process to hospital leadership, medical staff, and quality staff as appropriate. This position will support the medical staff and medical committees with a focus on peer review such as MSQI, service line committees and the organization through use of clinical expertise in review of concerns regarding quality of clinical care. The Peer Review Specialists collaborates with the medical staff leadership including multiple hospitals Peer Review Committees, The Medical Executive Committee (MEC), and the Medical Research, Education and Affairs Committee.

This person will collaborate with members of the Risk Management, Patient Safety and Quality, Information Technologies, Clinical Resource Management and others as needed to obtain information related to performance of peer duties and responsibilities. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Allegheny Health Network.                                                                                                                               

ESSENTIAL RESPONSIBILITIES:

• Oversees the day to day peer review process from acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. (20%)
• Ensures compliance to all standards and regulations involving medical staff peer review.  Also, ensures compliance with the peer review process as outlined in the Medical Staff Bylaws and regulatory requirements. Proactively reviews professional sources for changes in the peer review process, regulatory changes, and legal.  Responds to external audits triggered by quality incidence or performance issues. (20%)
• Secures all documents utilizing legal peer review protection.  Maintains systems and processes of review (Paper, Electronic) per applicable regulations and laws for confidentiality and record maintenance. (15%)
• Develops a mechanism to distribute peer review findings and actions throughout the organization while preserving confidentiality.  Cultivates a supportive and accountable warning / escalation system regarding peer review. (15%)
• Schedules and prepares for meetings as appropriate (Room reservations, agenda management, minutes, food, equipment, etc).  Collaborates with physician leadership regarding peer review for hospital level meetings ie: Medical Staff Quality Improvement (MSQI), Department Peer Review Meetings; Orthopaedic (Ortho), Obstetric/Gynecologic (Ob/Gyn), Pediatric (Peds), Trauma Transportable Physician Orders for Patient Preference/Peer Review (Trauma TPOPP/Peer Review) , Surgery, etc.  Incorporates information from RL Solutions reports, adverse events, and other sources into the peer review process. (20%)
• Ensures confidentiality with patient and physician information, PHI, and demonstrates understanding of HIPAA. (5%)
• Answers the phones and responds to customer needs professionally. Participates willingly in department meetings to enhance team work and efficiency within the department.  Willingly takes on additional assignments as needed within the department. (5%)

QUALIFICATIONS:

QUALIFICATIONS:

Minimum

• 3-5 years of previous clinical experience
• Registered Nurse (RN)

Preferred

• Bachelor’s Degree in Healthcare or Business
• 3-5 years of previous quality improvement or patient safety experience

SKILLS:

• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to use word processing, spreadsheet, power point presentation, and third party vendor specific software (Midas, RL Solutions, etc)
• Advanced knowledge of healthcare regulations, accreditation guidelines and standards related to the peer review process
• Positive and highly effective interpersonal and written and verbal communication skills
• Ability to work effectively with various levels of management personnel, physicians, board members, and other community members
• Advanced skills in leadership and facilitation, decision-making, change management and conflict resolution
• Excellent Time Management And Organizational Skills
• Excellent analytical, critical thinking, and problem-solving skills
• Ability to manage multiple priority projects simultaneously
• Able to work flexible hours as needed
• Able to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions
• Demonstrates ability to maintain information in a confidential manner

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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