RN Peer Review Analyst, Qualtiy Review, Full Time, Days

PIH Health • Los Angeles, CA

1d

About The Position

Responsible for retrospective review of medical records and compiling data to validate quality and appropriateness of care and accuracy of documentation. The RN Peer Review Analyst audits charts for appropriateness of admission, continued stay, compliance with hospital metrics, and care provided by caregivers. The role interacts with physicians, nurses, and other professionals regarding chart documentation and participates in team meetings to help improve charting for physicians and clinical staff. Cases that do not meet approved guidelines are selected for peer review and follow-up.

PIH Health is a nonprofit regional healthcare network serving approximately 3 million residents in the Los Angeles County, Orange County, and San Gabriel Valley region. Its integrated network includes three hospitals, outpatient medical office buildings, a multispecialty medical group, home healthcare and hospice services, and a range of specialty and urgent and emergency care services.

Requirements

• Organizational, analytical, writing, and interpersonal skills.
• Dependable and self-directed.
• Critical-thinking, problem-solving, and deductive-reasoning skills.
• Basic computer skills and familiarity with Windows-based software programs.
• Knowledge of Medicare Part A and Part B.
• Understanding of the regulatory environment.
• Understanding of and support for documentation strategies.
• Ability to understand and communicate Medicare requirements and how they affect DRG assignment.

Responsibilities

• Review medical records retrospectively and compile data to validate quality and appropriateness of care and accuracy of documentation.
• Audit charts for appropriateness of admission and continued stay, compliance with hospital metrics, and monitoring of care provided by caregivers.
• Interact with physicians, nurses, and other professionals regarding chart documentation.
• Participate in team meetings to help improve charting for physicians and clinical staff.
• Select cases that do not meet approved guidelines for peer review and follow-up.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed