Quality Review Specialist

Nevada System of Higher Education•Skokie, IL

2d•$39 - $60•Onsite

About The Position

This role is responsible for coordinating the medical staff peer review process for designated Entity departments and system service line(s). The specialist will prepare peer review case summaries, ensure appropriate routing to physician reviewers or committees, and collect, review, and analyze clinical data and documentation. The position also involves facilitating peer review committee meetings, preparing executive and board-level reports on practice trends and quality initiatives, and collaborating with Medical Staff Leadership to develop relevant indicators. Additionally, the specialist will support ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE), ensure compliance with The Joint Commission (TJC), CMS, and hospital policies, and support accreditation activities. This role serves as a key content expert for physician orientation and education on peer review processes, just culture principles, and quality improvement, providing guidance to other stakeholders. The specialist will also work closely with the Medical Staff Office to support credentialing and reappointment processes, and support nursing peer review, quality of care reviews, and other quality initiatives.

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 in a 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.
Act as a key content expert for physician orientation, education on peer review processes, principles of just culture, and quality improvement.
Provide guidance and education for other key stakeholders.
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.
Conduct quality of care, outcome clinical reviews (e.g. Patient Safety Indicators, QIO, etc.) including data trending and performance opportunities.
Participate in other quality initiatives and projects as assigned.