Director Peer Review

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

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Job Summary
The Peer Review Director directs all activities of the CVH, SVH/SRC Medical Staff (MS) Peer Review program, the MS Committee for Professional Enhancement (CPE) (Peer Review Committee), MS Utilization Review (UR) program and Utilization Review Committee (URC), and the Diagnostics Excellence program. The Medical Staff of SRH is made up of over 700 healthcare providers practicing at Skagit Valley Hospital (SVH), a 148 bed acute care hospital; Cascade Valley Hospital (CVH), a 47 bed acute care hospital; 23 Skagit Regional Clinics (SRC) that report as departments to SVH; 2 Wound care centers; Arlington Ambulatory Surgery Center; Mount Vernon Surgery Center; and SRH Regional Cancer Care Center.

Essential Functions
Responsibility includes addressing concerns that are identified regarding patient safety, medical necessity of admissions, lengths of stay, and observation services through the CPE and URC processes. Responsibility for chart reviews/audits to determine areas for improvement, identifying quality issues, and determining compliance with quality and regulatory initiatives. Using the Midas quality system, prepares abstracts for provider review and coordination of the full case review process that includes in the SRH MS Ongoing Professional Performance Evaluation (OPPE) process. The Peer Review Director educates and directs the functions of the MS CPE and URC keeping the members on point and on task. Performs all the provider correspondence, maintains records of same, and prepares the agendas and meeting minutes. Through the Midas quality reporting system, the PR Director also manages the activities for the MS Education letter and trending program which is based upon provider directed indices. The responsibilities include the correspondence to providers and management of data used for the medical staff OPPE process. The OPPE data is aggregated, analyzed, and reported to the MS division chiefs, the MS credentialing committee, Medical Executive Committee (MEC), and the Board of Commissioners as required by DNV. The Peer Review Director also reviews and screens all deaths to determine opportunities for improvements in health care delivery. Data reports are documented in Midas identifying potential areas for improvement and summaries of deaths are submitted to the Chief Medical Officer/VPMS for review. Through the Midas quality incident reporting system the Peer Review Director reviews all electronic Quality Management Memos (eQMM) submitted to the facility which reference medical care provided by MS and routes/intervenes as appropriate with actions as noted above, case review, rule break, RCA, etc. Peer Review Director is an active member of the Nursing Case Review Committee (Nursing Peer Review).
The Peer Review Director directs all the activities of the CVH, SVH/SRC MS UR program and URC. Responsibility includes directing the URC in addressing concerns that are identified regarding medical necessity of admissions, lengths of stay, and observation services.
Conducts case reviews and peer review activities in a timely manner. Manages the activities of the Peer Review Committee and covering over 500 medical staff members. Develops correspondence with providers for Peer Review and Rule Breaks and collects data for all activities. Manages committee functioning and documentation. Acts as clinical resource for the review of all (e-QMMS) pertinent to medical care and other clinical situations. Utilizes expert clinical knowledge of medical disease processes and medical/procedural terminology in all aspects of/and multiple specialties of healthcare. Comply with SRH policies and procedures. Performs other duties as assigned.

Education
Master’s degree in nursing or other healthcare field required.

Experience/Training
Minimum 10 years of recent nursing experience in acute care settings required. Additional experience in clinic settings or outpatient settings beneficial. Experience in quality management and/or case management in a healthcare environment possessing an understanding of quality improvement principles, theories, and tools. Peer review experience and/or medical record clinical review experience including data abstraction, analysis. Project/program management experience including project/program development, management and execution. Experience working collaboratively with executive and physician leadership to develop and implement strategic goals. Experience with performance improvement tools, methodologies, measurement, data analysis and a statistical background preferred. Experience as Nursing Director preferred.

License/Certifications
Current Washington State RN license required. CPHQ certification required within three (3) years of employment.

Other Skills
Proficient in EPIC or other Electronic Medical Records (EMR) systems. Understands Quality and Medical Staff database electronic systems. Demonstrated verbal and written communication skills and collaborative project management, excellent interpersonal skills. Demonstrated individual and group teaching skills. Able to perform medical record audits and compile information into aggregate information. Clinical database entry and management skills preferred. Ability to apply independent critical thinking and problem solving skills. Effective verbal and written communication skills. Ability to organize and prioritize workload to meet deadlines and demands of the Medical Staff, peer review committee, medical staff services, and administration. Must possess ability to handle a variety of problems and situations, often of extreme urgent and confidential nature. Must be able to work independently and use independent judgment to perform a wide variety of tasks in a professional way.

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.