Description

Title: RN, Coordinator Quality Peer Review



Location: Long Beach



Department: Q uality Assurance



Status: Full-time



Shift: Day



Pay Range* : $53.97/hr - $78.24/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.



Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.



Position Summary



Coordinates evaluation of quality patient care data and physician peer review of identified variances by organized committees of the medical staff at Long Beach Medical Center and Miller Children's and Women's Hospital.

Essential Functions and Responsibilities of the Job

1. Conducts primary or secondary screening of patient care variances to identify those cases warranting physician review. Evaluates variance of montioring functions to identify those meeting criteria for physician review (mortality, morbidity, blood usage, infection, adverse drug reactions, unusual occurrences). Initiates periodic physician review of screening criteria to validate currency, relevance and appropriateness. Coordinates statistical process review of selected diagnoses and procedures for medical staff review.
2. Prepares individual case referrals for physician review with appropriate supporting, background documentation. Works through medical staff coordinator to facilitate timely referrals, initiate measures to promote a thorough physician review with an objective outcome. Attends multidisciplinary medical staff peer review committee meetings as cases are presented and reviewed. Enters outcomes of physician peer review into appropriate software system. Provides summary reports to medical staff committees, as well as physician specific reports for credential committee and physician profiles.
3. Liaison with Quality Department and External Payors as needed to orchestrate response to quality issues identified by external payors, disseminate information in a timely manner, and assist with continuous readiness activities.
4. Participates and contributes to the design/maintenance of QI software for tracking and retrieval of quality information. Provides timely, accurate input on peer review and focus study process. Initiates revisions of ineffective or impractical indicators.
5. Maintains high level of confidentiality in issues identified and referred, medical record review process, results of review, and discussions during medical staff committee meetings.
6. Consistently applies infection control policies/procedures. Meets population specific competencies. Attends department education/training in-services. Participates in specific performance improvement projects. Performs data management activities/documentation. Utilizes appropriate applications such as QualCare, Crimson, Excel, etc.
7. Performs other duties as assigned.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Qualifications/Work Experience:

• Minimum 3 years' acute hospital setting experience preferred
• UR/QA/QI/RM/Case Management experience.
• Knowledge of various agencies and regulations pertaining to TJC, CMS, CDPH, CCS, Medi-Cal, IMQ, etc.
• Expertise with computer applications/software i.e., Excel, QualCare, Crimson.

Education/Licensure/Certification:

• Current Registered Nurse (RN) license in state of California required.