Quality Review Specialist

Endeavor Health•Glenview, IL

1d•Hybrid

About The Position

The Quality Review Specialist will coordinate the medical staff peer review process for designated Entity departments and system service line(s). This role involves preparing peer review case summaries, ensuring appropriate case routing to physician reviewers or committees, and collecting, reviewing, and analyzing clinical data and documentation related to potential peer review cases. The specialist will also facilitate peer review committee meetings, including agenda, minutes, and key follow-ups, and prepare Executive and Board-level reports on practice trends, improvement activities, and adjudication activities. Additionally, this position supports ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE), ensures compliance with The Joint Commission (TJC), CMS, and hospital policies, and acts as a key content expert for physician orientation and education on peer review processes, just culture principles, and quality improvement. The role also supports credentialing and reappointment processes, nursing peer review, quality of care reviews, and other quality initiatives and projects.

Requirements

Bachelor's degree in a clinically focused area (e.g., Nursing, Occupational Therapy, Physical Therapy, Pharmacy, Health Information Technology, or other healthcare-related field).
Registered Nurse (RN) licensure in State of Illinois or other relevant clinical license in the State of Illinois
5 – 7 years of clinical experience

Nice To Haves

Master's degree clinically focused area (e.g., Nursing, Occupational Therapy, Physical Therapy, Pharmacy, Health Information Technology, or other healthcare-related field).
Certified Professional in Healthcare Quality (CPHQ)

Responsibilities

Coordinate the medical staff peer review process for designated Entity departments and system service line(s).
Prepare peer review case summaries and ensure appropriate case routing to physician reviewers or committees.
Collect, review, and analyze clinical data and documentation related to potential peer review cases.
Facilitate peer review committee meetings including agenda, minutes, and key follow ups in collaboration with Medical Staff Department Chair(s).
Prepare Executive, Board level reports including practice trends, improvement activities, and adjudication activities of the peer review/quality committees
Collaborate with Medical Staff Leadership to develop relevant, specialty specific rate, rule, and peer review indicators
Support and facilitate ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) per policy
Ensure compliance with The Joint Commission (TJC), CMS, and hospital policies regarding Medical Staff peer review, OPPE, FPPE, and quality.
Support for accreditation activities including Medical Staff standards compliance and survey ready mindset
Key content expert for physician orientation, education on peer review processes, principles of just culture, and quality improvement.
Provides guidance and education for other key stakeholders as well.
Work closely with the Medical Staff Office to support credentialing and reappointment processes with OPPE, peer review outcomes.
Support nursing peer review practice, indicator development, data trending, and improvement
Quality of care, outcome clinical reviews (e.g. Patient Safety Indicators, QIO, etc.) includes data trending and performance opportunities
Other quality initiatives and projects as assigned