Peer Review Specialist Day Shift-, Quality Resources, Glendale

Peer Review Specialist, Full Time, Day Shift-9 Hrs, Quality Resources, Glendale

Glendale, CA, United States

Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. We are committed to the development and empowerment of our nurses and have received Magnet designation from the American Nurses Credentialing Center.

Glendale is known for its urban living, with easy access to dining, entertainment, shopping, amusement parks and outdoor recreation. Adventist Health Glendale is proud to be part of the thriving, diverse community since 1905.

Job Summary:

Maintains responsibility for the Peer Review/ Case Review function. Participates in data collection for submission to national databases, as well as studies, research, or projects requiring data collection to evaluate practice patterns, interventions, outcomes, and TJC compliance. Assists with preparing case summaries, timelines, initial RCA for complicated cases. Creates aggregate, trended reports for the medical staff and works with the physician profiles.

Plans, revises and implements risk management programs and solutions based on best practices and data analysis. Acts as a technical subject matter expert in own and possibly related discipline(s). Has substantial understanding of techniques, processes, procedures to perform the job and seeks to complete tasks in creative and effective ways. Runs program(s) with moderate budget/impact.

Job Requirements:

Education and

Work Experience:

• Associate’s/Technical Degree or equivalent combination of education/related experience:
  Required
• Bachelor's Degree:
  Preferred
• Five years’ technical experience:
  Preferred

Essential Functions:

• Abstracts data from charts in accordance with established criteria by completing forms correctly and expediting submission to Peer Review or in a national databases and/or registries on time for external reporting. Keeps review process within 30 – 60 days of discharge.
• Coordinates, facilitates, and organizes use of databases, particularly the peer review database. Acts as a resource for PLATO software system, able to set up special studies and run reports from PLATO program. Develops conflict solutions based on data analysis and trends.
• Demonstrates ability to appropriately collect and analyze information, reach decisions, take appropriate action, and follow through within scope of responsibility. Utilizes computer program to identify co-morbidities, complications, and performance measurement compliance. Contributes to better understanding and interpretation of criteria for case review.
• Prepares aggregate trended reports for the medical staff departments and committees. Is knowledgeable of CMS HQI pay for performance program. Works with creation and maintenance of physician profiles for credentialing. Completes other studies as defined (i.e. blood review, autopsy review, operative procedures and other reports as requested). Completes other studies as defined (i.e. Blood review, autopsy, operative timely ongoing). Compiles separate trended reports using statistic tools, and other relevant graphics.
• Prepares clinical outcome reports from Premier Perspective software for use in the Performance Improvement Program. Enters the data into various computer programs and is responsible for running reports as needed. Prioritizes and manages work load to assure completion of required reviews and other job functions within allotted time according to external reporting requirements and organizational priorities.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
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