VA Program Educator/Quality Assurance Review Nurse

Position Description: VA Program Educator/ Quality Assurance Review Nurse

Reporting to the Project Manager (PM) , the VA Program Educator/ QA Review Nurse/ provides ongoing education to new and existing review panel members to facilitate their successful participation in the Veterans Health Administration (VHA) Clinical Peer Review program. She/he collaborates with Senior Leadership and PRITM?s Education and Outreach Division to develop and maintain, current, standardized orientation materials, including case examples that reflect and respect the Client?s needs. Provides support to the Medical Directors in answering peer reviewers questions about navigating VA/government systems or how to locate case-specific documents. The QA Review Nurse/Educator will also perform QA review of peer reviewed case reports to ensure compliance with contract metrics.

Responsibilities:

• Understand and represent PRI?s mission, vision, and values to all internal and external customers
• Interact with government and private sector clients, partners, peer reviewers and PRITM staff in a professional and accountable manner, and as a representative of PRITM management
• Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
• Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations
• Maintains an up to date orientation schedule and calendar of appointments with reviewers which is shared with the PC/PM
• Interact with project team members to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRITM 's ISO requirements
• Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRITM standards and/or corporate contract standards have not been met. Communicating outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
• Assists in development and maintenance of standardized orientation materials and case examples.
• Collaborates with Senior Leadership and Education & Outreach Division to ensure orientation materials conform to theories and approaches for adult learning.
• Provides orientation and education to new and existing peer reviewers regarding such things as the process to complete case assignments, navigating the VA EHR and government systems, and submission of completed cases; refers clinical questions to Medical Director as needed.
• Identifies opportunities for continuous quality improvement in education and orientation through feedback from peer reviewers.
• May screen cases upon intake for referral to peer reviewers if needed
• As needed, performs QA review of peer reviewed cases in accordance with Veterans Health Administration requirements
• Works independently to complete assigned trainings; seeks guidance from PM as needed to establish priorities
• Flexible with assignments to meet contract performance metrics
• Participate in interdisciplinary collaboration with PRI staff, recognized teaming partners, and/or subcontractors
• Meets productivity and quality check measures
• When completing QA reviews utilizes the Veterans Health Administration (VHA) electronic medical record system to verify specific details included in the peer review report, such dates of service, laboratory values, vital signs, etc.
• Perform medical record review in accordance with all State, Federal and/or commercially mandated regulations
• Maintain compliance with all regulation changes as they impact VA medical and utilization review practices
• As directed, analyze patient records and participate in interdisciplinary collaboration with PRI staff and all recognized teaming partners and/or subcontractors
• Utilize VA electronic health information imaging
• Utilize Internet and Intranet resources for applicable research, e.g., evidence-based standards of care guidelines, quality measures, etc.
• Understand and represent PRI?s mission, vision, and values to all internal and external customers
• Perform other duties as requested