This position is responsible for administering and guiding physicians with the peer review process, and providing leadership and direction of assigned/ independently organized committees. Review medical records for standards of practice. Maintain strict confidentiality of all peer review records and outcomes. Identify trends in clinical outcomes and present data and recommendations to the Peer Review Committee. Participate in clinical practice management and performance improvement by monitoring the quality of care provided to patients. Document objective findings against approved indicators, provides support for peer review by the Medical Staff, identifies trends in clinical outcomes and presents data to the Peer Review Committee of the Medical Staff, Credentials Committee, and others within the peer review system. Coordinates the Focused Physician Practice Evaluation (FPPE) process as directed by the Peer Review Committee.
The individual works in collaboration with the Chair of the Quality Management Committee, the Medical Staff Office (including the Chief Medical Officer, Medical Director and Director), the Chief Nursing Officer and Patient Care Directors, Risk Management, Patient Safety and others in support of improvement of quality issues, including physician and clinical performance. Maintains and analyzes electronic databases in support of quality improvement. Participates in hospital Pl initiatives. Provides leadership and facilitation support to various improvement teams as appropriate. This individual is responsible for supervising Quality Analysts in the event they are needed to support this role.
EDUCATION: Bachelor's Degree or equivalent in Nursing, Health Sciences or medical related field required, or graduate of accredited nursing program with five years of clinical experience and two years of significant demonstrable experience in clinical data and outcome analyses.
CERTIFICATION/LICENSES: Current New Mexico Nursing License required. Current CCM (Certified Case Management) or CCRN (Certified Critical Registered Nurse) preferred. Certified Professional in Healthcare Quality (CPHQ) desirable.
SKILLS: Positive relationship building, effective written/verbal communication, ability to effect change, perform critical analysis, plan and organize effective committee processes. Strong organizational skills. Ability to define problems, collect data, establish facts, draw valid conclusions and provide sound, cogent recommendations. The ability to analyze complex medical issues and to review medical records for appropriateness of medical management. Knowledge of third party administrator and CMS expectations of medical care.
Facilitative leadership skills. Strong interpersonal skills including mentoring and coaching. Ability to problem-solve and appropriately confront issues. Effective oral, written and presentation skills. Proficient computer, research and data management skills. Demonstrated ability to make public presentations to both large and small groups, and to articulate information or data to multiple audiences with varying degrees of knowledge and expertise. Ability to work across disciplines and departments, and to manage by influence in a consultative role.
Demonstrated skills using health-care databases, and Microsoft Word, Excel, PowerPoint or equivalent programs. Ability to read, write, and communicate verbally in English.
EXPERIENCE: Minimum of five years of experience in an acute care setting. Case management and/or utilization review experience desired. Two years of data collection and analysis, or similar performance improvement experience preferred.
NATURE OF SUPERVISION:
-Responsible to: Executive Director of Performance Improvement
PHYSICAL REQUIREMENTS: Ability to move around the hospital to all units/departments for about 20% of the day, sitting in office 80% of the day. Extensive use of a computer for required applications. Requires close work, good vision, dexterity to write as well as to type.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.