CLINICAL REVIEW SPECIALIST-RN-PATIENT SAFETY/RISK MANAGEMENT

North Oaks Health System-posted 2 months ago
Full-time
Hammond, LA
501-1,000 employees
Religious, Grantmaking, Civic, Professional, and Similar Organizations
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The Clinical Review Specialist RN is responsible for performing clinical chart reviews for purposes of peer review, performance improvement and identification of safety opportunities. Provides support for provider services, clinical services, patient safety, external review, and performance management. Position is also responsible for supporting the system wide Performance Improvement initiatives by serving on projects that provide quality or safety assessment for clinical performance enhancement. Ensures compliance with all nationally recognized clinical standards of practice as adopted by the organization and in alignment with internal policies. This role is full time, Monday through Friday, 8am - 4:30pm. Exempt.

  • Supports the provider peer review and profiling process.
  • Communicates with Health Information Management, Information Systems, Case Management, Nursing and other hospital departments to assure maximum use of all available data sources for projects assigned.
  • Works with Leadership to develop educational programs for medical staff and/or patient care departments.
  • Maintains confidentiality of information pertaining to patients, families, visitors, medical staff, and personnel in accordance with hospital policies and procedures and Medical Staff Bylaws.
  • Works with other department personnel to ensure that most efficient and effective methods of profiling are implemented.
  • Collaborates with other members of the Patient Safety/Risk Management Department for the timely completion of all department projects.
  • Handles provider referral calls and provides appropriate information to callers.
  • Generates preliminary reports and data analyses for review and finalization by designated leadership for presentation at hospital and medical staff meetings.
  • Works with patient safety staff and leadership to investigate and analyze actual and potential events that pose a risk to patient safety, related to medical and other clinical staff practices.
  • Assists with data collection and display of report formats for programs utilized by the Quality Division and Provider Services.
  • Works directly with and takes direction from the Manager Patient Safety, CQHEO, CMO and Physician Services regarding OPPE, FPPE and provider peer review process.
  • Serves as a resource to PI teams addressing performance improvement opportunities identified via medical initiatives as agreed upon by Leadership.
  • Corresponds with the medical staff and hospital leaders on assigned projects including letters for information, referred cases, and findings/results.
  • Reports to Leadership any actual or potential injury for patient as related to peer review findings.
  • Serves as a resource for medical/risk inquiries from providers, nurse administrators, and others regarding emergent patient care issues and loss control.
  • Accesses and utilizes databases to support provider peer review processes.
  • Participates on CQI Teams formed as a result of projects assigned.
  • Participates in Joint Commission and/or other accreditation survey activities, as related to Peer Review, OPPE, FPPE, and Reappointment.
  • Works with Chief Medical Officer to develop, implement, and monitor OPPE and FPPE.
  • Facilitates PPEC, including the intake, processing, and reporting/follow-through for all reported provider peer review-related events.
  • Performs other related duties as assigned by supervisor.
  • Follows North Oaks Health System's compliance programs and all federal and state regulatory guidelines.
  • Minimum of three years of clinical experience.
  • Current LA RN license.
  • Associate degree.
  • Critical Care experience.
  • Bachelor's degree.
  • Good written and verbal communication skills.
  • Computer skills: must be able to use Word and Excel proficiently.
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