Clinical Quality Reviewer

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Job Summary
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Under the leadership of the Manager of Quality and Safety, the Clinical Quality Reviewer (CQR) is responsible for the collection and accurate submission of data through workstations and the identification of opportunities for quality improvement.

The CQR works in collaboration with Physician Champions, medical staff, leadership, the Infection Control and Quality Improvement team, and front-line employees to use data to improve patient outcomes. Strives for superior performance by consistently providing a product or service to leadership and staff and is recognized as ultimately contributing to the patient and family experience.

• Data Collection and Reporting
• Responsible for collecting, analyzing and reporting clinical data elements on eligible cases as required for participation in Collaborative Quality Initiative (CQI).
• Independently manage the case load and report data to Collaborative according to established standards and deadlines.
• Identifies patients for inclusion in the program(s) through the application of program inclusion/exclusion criteria and protocols.
• Identifies the appropriate resources necessary in obtaining valid, reliable data for entry into the program(s).
• Demonstrates effective utilization of the hospital medical records systems in the collection of data components specific to the program(s).
• Identifies opportunities for streamlining and process improvement in the data collection process.
• Utilizes software applications for data collection and analysis.
• Responsible for the accurate and timely entry of the data into the program databases and meets the caseload accrual requirement protocol.
• Reviews weekly site accrual report on the database and responds to accrual reports alert (as applicable).
• Maintains regular contact with the physician champion(s) and other members of the team at Memorial Healthcare.
• Prepares for and is available for site audits.
• Attends Collaborative-wide meetings and sub-group meetings as a representative of Memorial Healthcare.
• Acts as a resource regarding the Collaborative within Memorial Healthcare.
• Resolves data discrepancies, and responds to HMS coordinating Center requests in a timely fashion.

• Core Measure Abstraction
• Performs chart abstraction for selected measures related to the CMS/Joint Commission Core Measures and others as assigned.
• Maintains abstraction accuracy of at least 90% as validated by internal and external audits.
• Performs concurrent review of key core measure processes to ensure timely compliance.
• Collects data for other selected hospital quality initiatives including but not limited to:
  Michigan Hospital Association initiatives, Midas, The Joint Commission and Leapfrog.
• Collects data for measures related to Pay for Performance and Value Based Purchasing initiatives.
• Conducts chart review for other indicators such as medical, surgical, maternal or fetal complications, mortalities, readmission, sepsis and hospital acquired conditions as requested.
• Analyzes data for trends and improvement opportunities.
• Creates reports and presentations of data in appropriate formats for individual and audience presentations.
• Presents quality data at assigned medical staff department meetings, including recommendations for improvement and facilitation of group discussion.

• Quality Improvement
• Actively engage in Collaborative activities and identify opportunities to improve the quality of care and patient outcomes at Memorial Healthcare.
• Collaborates with the Physician Champions to use data in identifying opportunities for Quality Improvement.
• Plays key role in the development of Quality Initiatives based on data.
• Implements best practices recommendations as appropriate and in collaboration with relevant individuals and/or groups.

• Works Effectively with Patients, Families, and Staff
• Establishes effective working relationships with members of the hospital community.
• Contacts physician offices and/or clinics via telephone and/or written communications as necessary to facilitate collaborative objectives.
• Contacts patients and/or families via telephone and/or written…