Coordinate evaluation of quality patient care data and physician peer review of identified variances by organized committees of the medical staff at LBM and MCWHLB.
Duties and Responsibilities:
Conduct primary or secondary screening of patient care variances to identify those cases warranting physician review: —Evaluate variance of monitoring functions to identify those meeting criteria for physician review (mortality, morbidity, blood usage, infection, adverse drug reactions, unusual occurrences). —Initiate 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.
Initiate referral process to the appropriate medical staff peer review group in coordination with medical staff coordinator: —Prepare individual case referrals for physician review with appropriate supporting, background documentation. —Work through medical staff coordinator to facilitate timely referrals, initiate measures to promote a thorough physician review with an objective outcome. - Attend multidisciplinary medical staff peer review committee meetings as cases are presented and reviewed. —Enter outcomes of physician peer review into appropriate software system. —Provide summary reports to medical staff committees, as well as physician specific reports for credential committee and physician profiles.
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 to applicable individuals. —Assist with continuous readiness activities.
Participate and contribute to the design/maintenance of QI software for tracking and retrieval of quality information: —Provide timely, accurate input on peer review and focus study process. —Initiate revisions of ineffective or impractical indicators.
Maintain high level of confidentiality in ll aspects of performance: —Confidentiality of issues identified and referred. —Protection of medical record during review process. —Confidentiality of results of review.—Confidentiality of discussions during medical staff committee meetings.
Clinical Background; —Minimum three years experience in acute hospital setting
Previous 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 ie. Office, Word, Excel, etc.
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