Medical Staff Quality Specialist NE -- Medical Affairs -- General Hospital

Charleston Area Medical Center Health System•Charleston, WV

15d•Onsite

About The Position

Support Vice President for Medical Affairs for provision of expertise and facilitation to elected Medical Staff leaders, Medical Staff committee chairs, and Clinical Directors for carrying out their oversight accountabilities for the quality of medical care in conformance with the medical staff governing documents, accrediting body accreditation standards, Health Care Quality Improvement Act (HCQIA), and pertinent regulatory and legislative requirements.

Requirements

Bachelor's Degree (Required)
7 - 10 years experience as a combination of clinical nursing, criteria based peer review, performance improvement, and med Staff Committees/Activities.
Registered Nurse (Required)

Nice To Haves

Master's Degree
Software experience preferred: RLDatrix, MD STAFF, MD STAT, Cerner Lights on, Premier Physician Focus, Cerner, and Microsoft Office
BSN and 10 years extensive experience in areas relevant to the scope may be substituted for Masters Degree and 8 years experience

Responsibilities

Support the Chair of the Committee for Professional Enhancement (peer review) in agenda development, triage of case reviews, minutes and communication with Clinical Quality Specialist. Prepare CPE report to MEC.
Function as a resource and partner to the Clinical Quality Specialist in development, guidance and presentation of indicators to the Committee for Professional Enhancement (peer review).
Responsible for triage of patient complaints, grievances, safety reports and other intakes of issues related to credentialed providers. Conduct fact finding reviews, timeline preparations when necessary chart reviews and presentation to the leadership council for recommendations and actions taken.
Responsible for the management and development of ongoing professional practice evaluations for eight(8) medical staff departments and occasional support for the other departmental medical staff quality specialist as needed. Develop appropriate quality indicators and scorecards (OPPE) for the individual providers on an annual basis within assigned departments and understand triggers that would prompt additional department chief review and consideration of next steps.
Attend Credentials Committee planning and Credentials Committee meeting to validate new applicants coming through the process in order to familiarize with the applicant and obtain awareness of any special privileges that would require proctoring.
Collaborate with the credentials manager to oversee the proctoring process in for all provider as applicable in eight (8) departments. Prepare appropriate documents timely and provide to Credentials Department as completed reports for review by the medical staff.
Coordinate and provide support to the Chief of Staff Investigative Committees in concordance with the Medical Staff Governing Documents, HCQIA and Medical Staff procedures.
Collaborate with Risk Management (Patient Safety) and Office of General Counsel reporting incidents/occurrences, which may result in professional liability claims.
Manage and improve software capabilities working with the provider data management specialist to include management of peer review, OPPE and other key processes critical to the work of the quality specialist.
Manage referrals to external peer review agencies in coordination with the medical staff, medical records and other key departments.
Attend accreditation survey sessions to present process and provider data as appropriate to the review being conducted.
Responsible for serious adverse event call annually (avg. 3-4 times per year)
Train and participate in internal auditing procedures through the regulatory office.
Attend and support all medical staff committees as assigned.
Coordinate, review and develop responses to Third Party Payer/Insurance Reviews/Compaints.
Maintain credentialed provider health records as needed.
Work in collaboration with Trauma Coordinators to ensure Peer Review policy is followed.
Serves as M&M committee resource to assure compliance with Medical staff governing documents.