Clinical Quality Review Specialist
1 day ago
Clinical Quality Review Specialist
**Job Summary**
We are seeking a highly skilled Clinical Quality Review Specialist to join our team at Hoag Memorial Hospital Presbyterian. As a key member of our clinical services team, you will be responsible for developing and coordinating an effective and continuously improving healthcare practitioner peer review program.
**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
* Coordinates and leads regular peer review body meetings
* Ensures follow-up actions on each case are implemented, e.g., education/training, monitoring/proctoring, change in privileges, behavior counseling, or summary suspension/termination
* Ensures 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
* Maintains complete and accurate records of peer review activities
* Develops and oversees operational quality indicators
* Assists the Director Clinical Services in preparation of reports and presentations
**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 Memorial Hospital Presbyterian**
Hoag Memorial Hospital Presbyterian is a nonprofit, regional healthcare delivery system in Orange County, California. We deliver world-class, comprehensive, personalized care, consisting of 1,800 top physicians, 15 urgent care facilities, 10 health and wellness centers, and two award-winning hospitals. Our healthcare services include seven institutes providing specialized services in cancer, digestive health, heart and vascular, neurosciences, spine, women's health, and orthopedics through our affiliate, Hoag Orthopedic Institute.
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