Quality Review Specialist-RN

Quality Management - Acute
Full Time
Day Shift
8-4:30

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care.

Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first Heart

CARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

The Quality Review Specialist-RN provides consultative services regarding quality assessment and trends to medical staff and to hospital ancillary department personnel. In this role, the employee will perform comprehensive retrospective reviews in a timely manner utilizing criteria developed and approved by the medical staff, hospital, and regulatory agents.

• Minimum Education:
  
  High School Diploma or Equivalent
• Minimum Years of
  
  Experience:
  
  4 Years of clinical or hospital experience; 2 Years of experience in quality or utilization review.
• Substitutable Education & Experience (Optional):
  None.
• Required Certifications/Licensure:
  Registered Nurse (RN)
• Required Training:
  None.

• Utilizes in-depth knowledge of clinical workflows, policies and procedures, patient care / clinical business processes, regulatory requirements, and best practices to:
  • Risk Management:
    • Perform daily review of new occurrence reports.
    • Identify occurrences that require additional follow‑up and report these to the Director or designee in a timely manner.
    • Ensure that occurrences are categorized correctly and all fields completed and correct. Verifies data accuracy with medical record if necessary.
    • Ensure that occurrence reports are forwarded to all appropriate persons.
    • Access other sources of data as needed for investigation and follow up.
    • Serve as System Administrator for the occurrence reporting system.
    • Primary liaison between Risk Management, Information Services, and system users.
    • Manage access to the occurrence reporting system.
    • Add new locations and new users and provide new‑user training. Assign passwords. Remove users as needed.
    • Provide new user training and ongoing user support, paying keen attention to user needs and opportunities to offer solutions and modify processes to improve efficiencies.
    • Coordinate with vendor and Information Services to troubleshoot system as needed.
  • Center for Best Practice & PN Quality:
    • Assist with development, implementation, and evaluation of the hospital’s overall quality improvement program.
    • Assist with coordination, preparation, and maintenance of performance improvement assessment and improvement activities.
    • Be responsible for data integrity and follow well defined processes for maintaining data integrity as well as manage assigned database.
    • Assist in evaluation, analysis, maintenance, and development of system functionality of the EHR to meet clinical objectives including participating in project plan development/tracking and workflow analysis.

• Provide accurate and timely routine statistical analyses and reports to designated parties. Identify need for new reports and develop and create reports. Generate user‑friendly reports from other databases.
• Evaluate and analyze data for trends, identify areas of concern, and use data display techniques to provide reports for various meetings and hospital committees.
• Prepare materials for meetings and assist with maintenance of performance improvement project records.
• Represent department on committees / teams as assigned.
• Participate…