Hybrid Senior Peer Review Specialist bei Stamford Health, Inc.
Stamford Health, Inc. · Stamford, Vereinigte Staaten Von Amerika · Hybrid
- Professional
- Optionales Büro in Stamford
The Medical Affairs Department at Stamford Hospital is seeking a Senior Peer Review Specialist to lead the medical staff peer review process across the system. The candidate will provide coordination and support to the overall process, working collaboratively with the Peer Review Manager, Clinical Department Chairs, Risk Management, the Peer Review Oversight Committee and the Medical Peer Review Committees. . The successful candidate will report to the Director of Medical Staff Services.
The successful candidate will identify cases from multiple sources for peer review of physician performance based on established clinical triggers and systematically summarize findings for presentation across high level committees. This position is required to fulfill the hospital’s growing regulatory requirements for peer review, including FPPE/OPPE and recredentialing processes.
Responsibilities
- Coordinating and providing support for Medical Staff peer review activities and committees within specified medical staff departments.
- Applying clinical knowledge to screening criteria to identify cases meeting established standards and determining those requiring further analysis.
- Systematically reviewing referred cases and communicating with relevant committees, department chiefs, and physicians to ensure appropriate peer review actions are taken.
- Formulating comprehensive case summaries and review questions for providers participating in the peer review process.
- Preparing detailed case summaries and actively participating in Multispecialty Peer Review Committee and departmental ad hoc peer review committee meetings.
- Serving as a liaison between committees to facilitate effective communication and seamless referral of cases.
- Facilitating systematic reviews of departmental screening criteria to maintain relevance and consistency in the peer review process.
- Providing first-level screening for the semiannual review of Ongoing Professional Practice Evaluation (OPPE).
- Assisting department chiefs with Focused Professional Practice Evaluation (FPPE) related to new privileges and professional practice reviews.
- Entering peer review data accurately and promptly into designated databases, ensuring the integrity of the information.
- Generating accurate and timely peer review meeting minutes to document discussions and outcomes.
- Maintaining knowledge and staying informed about Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) standards, medical staff bylaws, and hospital policies relevant to the role.
- Provide information and education on peer review process to medical and hospital staff as necessary.
- Performing additional duties and engaging in special projects as assigned.
- Support all peer review meetings, including the overall hospital Peer Review Oversight Committee, departmental, divisional and ad hoc peer review committees. Ensure that necessary documentation is generated within established timeframes and is reported to the Medical Executive Committee via the Peer Review Oversight Committee on a monthly basis.
- The Senior Peer Review Specialist will oversee day-to-day operations, attend, and provide support; including agenda, minutes, and follow up to hospital wide and department specific peer review committees and collaborate with Medical Staff Personnel.
- Initiate follow-up calls as necessary and gather information for meetings to assure a well-run meeting in collaboration with the Chair of the Peer Review Oversight Committee.
- Perform data-entry of peer review findings and maintain the peer review database to facilitate production of practitioner specific reports for FPPE and OPPE.
- Develop peer review policies and procedures, and continually develop and update forms necessary in the peer review process.
- Collaborate with the analytics, innovation and HIM departments to generate reports as required in order to highlight trends and opportunities for improvement, identifying cases for peer review meeting the approved criteria.
- Coordinate external peer reviews and the FPPE/OPPE process with Clinical Chairs.
- Ensure the capture, management and confidential dissemination of peer review referrals and materials.
- Coordinate among the multiple sources of peer review referrals (Case management, Risk Management, HIM, Quality, among others) into the peer review process.
- Perform review of each patient chart identified as a potential peer review issue to determine if the case is appropriate for peer review utilizing the EMR.
- Serve as liaison between the hospital and the Chair of the Peer Review Oversight Committee and the Clinical Chairs on issues related to the routine operation of the peer review process.
- Participate in Performance Improvement committees as necessary.
Qualifications
- Non licensed clinician (physician or nurse) or individual with healthcare related Master’s Degree from an accredited institution strongly preferred; consideration will be given to a candidate who has direct clinical experience but is not a practicing clinician.
- Experience performance improvement/quality and focused review.
- A minimum of 3 years’ experience in a hospital setting is required.
- A strong track record of working with physicians is essential.
- Familiarity with hospital medical records systems, EMR, and ability to interpret clinical notes in the medical record for peer review case identification is required.
- Ability to implement, utilizes, and educate on the principles of peer review and performance improvement.
- Excellent written, oral and communication skills are essential.
- Demonstrated organization skills are essential.
- Experience with credentialing software preferred.
- Competency with computer software such MS Office, Excel, and PowerPoint or equivalent is required.
