Clinical Quality Review Specialist

2 days ago


Costa Mesa, California, United States Hoag Memorial Hospital Presbyterian Full time
Job Summary

Hoag Memorial Hospital Presbyterian seeks a skilled Clinical Quality Review Specialist to develop and coordinate an effective and continuously improving healthcare practitioner peer review program. The ideal candidate will have a strong background in quality and risk management, with experience in coordinating and overseeing the process of performing objective medical record review.

Key Responsibilities

Develop and coordinate an effective and continuously improving healthcare practitioner peer review program
Coordinate and oversee the process of performing objective medical record review of each case for appropriateness of care based on evidence-based clinical care guidelines
Ensure follow-up actions on each case are implemented, e.g., education/training, monitoring/proctoring, change in privileges, behavior counseling, or summary suspension/termination
Ensure peer review activities are timely and meet all internal requirements and are compliant with external standards and regulations, state laws, and Medicare Conditions of Participation

Requirements

Associate's degree in nursing or another healthcare field
At least five (5) years clinical experience
At least one (1) year experience in quality and/or risk management work
Highly proficient with Microsoft Office suite of products, including Word, Excel, Outlook, and PowerPoint
Experienced user of Electronic Health Records (EHR)
Comprehensive knowledge of medical terminology

Preferred Qualifications

Bachelor's degree in nursing or another healthcare related field
Experience with EPIC
Experience in database management
Current licensure as a Registered Nurse in good standing in the State of California
Certifications Preferred

About Hoag

Hoag Memorial Hospital Presbyterian is a nonprofit, regional healthcare delivery system in Orange County, California. We deliver world-class, comprehensive, personalized care, with a team of 1,800 top physicians, 15 urgent care facilities, 10 health and wellness centers, and two award-winning hospitals. Our seven institutes provide specialized services in cancer, digestive health, heart and vascular, neurosciences, spine, women's health, and orthopedics through our affiliate, Hoag Orthopedic Institute. We are the highest-ranked hospital in Orange County by U.S. News & World Report and a designated Magnet hospital by the American Nurses Credentialing Center (ANCC).

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