Peer Review and Grievances RN

• Salary Range : $95,825.60 USD to $ USD

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Memorial Hospital of Gardena
Gardena, CA 90247, USA

The Peer Review & Grievances RN supports the Director Quality & Performance Excellence by coordinating clinical case review, physician peer review workflow, mortality and high-risk case screening, and hospital grievance management across Memorial Hospital of Gardena and Coast Plaza Hospital. The position ensures that cases are identified, organized, tracked and routed through the appropriate medical staff and hospital governance processes while maintaining confidentiality, timeliness, documentation integrity and clear follow-through on identified actions.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

• Screen assigned mortality, high-risk, adverse outcome, readmission, transfer, clinical deterioration and other cases for potential quality-of-care concerns using established review criteria.
• Prepare concise, objective clinical case summaries, timelines and supporting documentation for physician review and medical staff peer review activities.
• Coordinate case assignment to appropriate physician reviewers and track review completion, follow-up questions, committee disposition and assigned actions.
• Maintain peer review tracking systems, case status logs, due dates and documentation in accordance with approved processes and confidentiality requirements.
• Support the Director and Medical Staff leadership with recurring trend identification, practitioner-specific quality concerns, service-line patterns and opportunities that may warrant focused review or performance improvement.
• Support OPPE/FPPE-related case identification and data preparation when requested by Medical Staff leadership or the Director, consistent with established medical staff processes.
• Coordinate the hospital grievance process, including receipt, triage, investigation support, department follow-up, response drafting, tracking and closure.
• Ensure grievance reviews include appropriate clinical, operational and communication perspectives and are escalated when significant quality, safety, regulatory or physician-related concerns are identified.
• Track grievance themes and provide trend reports to the Director, Quality & Risk Manager, Patient Experience and relevant committees.
• Refer recurring system issues from grievance and peer review activity to the Quality Improvement & Patient Experience RN for structured improvement work.
• Support regulatory, accreditation and complaint-survey requests involving grievance or peer review process evidence as directed by the Director.
• Participate in selected RCA, case conferences, mortality review, quality committees and physician-related investigations as assigned.
• Maintain strict confidentiality of protected peer review, patient and practitioner information and use secure processes for case handling and communication.
• Communicate overdue reviews, unresolved clinical concerns and barriers to timely case closure to the Director.

• Maintain a centralized grievance log for both hospitals with date received, issue category, responsible department, investigation status, response due date, closure date and identified trends.
• Coordinate fact-finding with nursing, physicians, ancillary departments, Risk Management, Patient Experience and other stakeholders as appropriate.
• Draft clear, professional grievance responses for leadership approval without disclosing protected peer review information.
• Differentiate individual service recovery opportunities from recurring system issues requiring formal improvement or leadership escalation.
• Monitor timeliness and elevate cases at risk of missing organizational or regulatory response expectations.
• Maintain objective case chronology and supporting documentation.
• Facilitate review workflows through initial screening, physician review, committee consideration, action tracking and closure.
• Track cases requiring additional information, second-level review, focused evaluation or medical staff follow-up.
• Prepare de-identified or appropriately limited trend summaries for quality governance as directed.
• Support documentation of committee recommendations and ensure assigned follow-up is tracked to completion.

• Treats everyone as their customer; utilizes scripting and other tools to…