Quality Review Specialist RN - Surgical

Lexington Medical Center • West Columbia, SC

40d

About The Position

The Quality Review Specialist-RN provides consultative services regarding quality assessment and trends to medical staff and hospital ancillary department personnel. The role performs comprehensive retrospective reviews in a timely manner using criteria developed and approved by the medical staff, hospital, and regulatory agents.

The specialist uses in-depth knowledge of clinical workflows, policies and procedures, patient care and clinical business processes, regulatory requirements, and best practices to support Risk Management and the Center for Best Practice & PN Quality. Responsibilities include reviewing and investigating occurrence reports, administering the occurrence reporting system, supporting quality improvement and performance improvement activities, maintaining data integrity, analyzing and reporting data, and assisting with clinical information system functionality and workflow analysis. The role also supports patient safety investigations and corrective action plans, serves as a resource to hospital departments and committees, and represents the department on committees and teams as assigned.

Requirements

• High school diploma or equivalent.
• At least 4 years of clinical or hospital experience.
• At least 2 years of experience in quality or utilization review.
• Registered Nurse (RN) certification/licensure.
• Efficient use of software products such as Word, Excel, PowerPoint, and Outlook.
• Attain at least 12 hours of continuing education annually in topics related to the role.

Responsibilities

• Perform daily review of new occurrence reports, identify reports needing follow-up, ensure reports are correctly categorized and complete, verify data accuracy when needed, and forward reports to appropriate persons.
• Access other data sources as needed for occurrence investigations and follow-up.
• Serve as system administrator and primary liaison among Risk Management, Information Services, and users of the occurrence reporting system.
• Manage system access, add locations and users, assign passwords, remove users when needed, and provide initial and ongoing user training and support.
• Coordinate with the vendor and Information Services to troubleshoot the occurrence reporting system.
• Assist with development, implementation, and evaluation of the hospital’s overall quality improvement program.
• Coordinate, prepare, and maintain performance improvement assessments and improvement activities and project records.
• Maintain data integrity and manage assigned databases; audit database contents for accuracy and validity.
• Assist in evaluating, analyzing, maintaining, and developing EHR system functionality to meet clinical objectives, including project planning, tracking, and workflow analysis.
• Provide accurate and timely statistical analyses and reports; identify needs for new reports and develop them, including user-friendly reports from other databases.
• Analyze data for trends and areas of concern and use data-display techniques to prepare reports for meetings and hospital committees.
• Prepare meeting materials and maintain performance improvement project records.
• Represent the department on committees and teams as assigned.
• Support department goals, objectives, and timelines; manage multiple initiatives, work accurately and with urgency, demonstrate flexibility, and assist others.
• Complete at least 12 hours annually of continuing education related to the role.
• Research, investigate, and analyze data to resolve problems and recommend solutions; maintain support-call logs and track issues.
• Compile and maintain accurate occurrence data statistics.
• Participate in investigations of serious unanticipated events and close calls, and contribute to developing, implementing, and evaluating corrective action plans.
• Support a culture of safety by encouraging staff to report safety and quality issues.
• Identify improvement opportunities and coordinate or participate in action-plan development and implementation; recommend changes to systems or processes that do not produce desired outcomes.
• Collaborate and communicate with administration, Information Services, and clinical care teams in planning, developing, evaluating, and maintaining the Clinical Information System.
• Act as a resource for quality assessment activities with hospital departments and committees, and assist hospital personnel with establishing criteria and reviewing medical records.
• Use required software products, including Word, Excel, PowerPoint, and Outlook.
• Perform other duties as assigned.

Benefits

• Day-one medical, dental, and life insurance benefits.
• Health care and dependent care flexible spending accounts (FSAs).
• 403(b) match plan enrollment beginning day one; employer matches dollar for dollar up to 6%.
• Employer-paid life insurance equal to 1x salary.
• Optional supplemental life insurance with low-cost premiums up to 3x salary.
• Adoption assistance.
• Employer-paid short-term and long-term disability coverage for full-time employees after 90 days of eligible employment.
• Tuition reimbursement.
• Student loan forgiveness.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED