Manager Of Peer Review

DEPARTMENT /

LOCATION:

QUALITY ASSURANCE / STROGER SHIFT: 8AM-4PM

This position is exempt from Career Service under the CCH Personnel Rules.

The Manager of Peer is responsible for the coordination, administration, and operational oversight of Cook County Health’s (CCH) peer review and physician quality review programs in support of patient safety, quality improvement, regulatory compliance, and physician accountability initiatives. The Manager ensures peer review activities are operationally supported, data-driven, and aligned with CCH policies, accreditation standards, regulatory requirements, and medical staff bylaws.

The role serves as a liaison among operational, clinical, and physician leadership teams and leads initiatives to enhance the effectiveness, consistency, and integrity of peer review processes, reporting, and performance improvement efforts across the organization.

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policies and procedures
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

• Manages and oversees day-to-day peer review workflows and processes and physician quality review operations across departments and service lines.
• Coordinates case reviews, collection and analysis of supporting documentation, preparation of case summaries and reports, and facilitation of peer review committee activities.
• Collaborates with physician leadership, nursing leadership, quality, risk management, and medical staff services to ensure peer review activities are conducted in a timely, consistent, confidential, and effective manner.
• Shares peer review findings and process improvement initiatives committee recommendations.
• Supports development and implementation of peer review policies, workflows, educational materials and quality initiatives.
• Tracks action items, trends and follow-up activities resulting from peer review findings and manages intake, triage, prioritization, tracking and resolution of peer review cases.
• Conducts detailed chart reviews, documentation reviews and operational investigations prior to presenting to peer review committee.
• Prepares peer review agendas, case summaries, timelines, supporting documentation and presentation materials.
• Substantiates key operational details including documentation timing, escalation pathways, follow-up communication, and compliance with organizational protocols.
• Identifies systems and process issues, workflow gaps and operational improvement opportunities through peer review activities.
• Develops and…