Concurrent Quality Reviewer
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POST DATE 8/27/2016
END DATE 12/10/2016
Nassau Bay, TX
JOB DESCRIPTIONJob Summary
SUMMARY This position provides an essential component of the Performance Improvement Department workflow by reviewing and preparing adequate documentation to improve both external and internal data measure sets. Works directly with hospital employees, members of the Medical Staff, and patients to achieve superior quality of care as measured by compliance to quality indicators. Performs concurrent chart review of identified cases using established quality indicators and actively intervenes to meet established standards. Performs concurrent and/or retrospective screening for quality and risk management issues. Coordinates reporting results of quality findings to appropriate databases and reports risk management concerns to the department director. Assists with other audit activities including, but not limited to, new external databases, special studies, and internal operation audits.
DUTIES AND RESPONSIBILITIES
1. Concurrently reviews and analyzes inpatient record to ensure that compliance to quality indicators are met.
2. Intervenes and takes appropriate action to foster real-time compliance to core measures and other performance measures associated with certification programs and other regulatory, national, regional or locally- sponsored quality programs. Interventions to promote compliance may include discussion, and/or collaboration with physicians, nurses, other healthcare personnel and/or patients.
3. Provides as needed reports to appropriate parties showing a) compliance to core and other performance measures, b) analysis of problematic areas, and c) actions taken to improve compliance.
4. Assists in the implementation of DNV standards as part of processes and quality improvement across the continuum of care. Demonstrates an ability to learn and adapt to changes in regulatory requirements, criteria revisions, and departmental needs. Assists with intradepartmental data collection associated with various external, internal, and administrative audits and/or studies.
5. Exercises sound clinical judgment, discretion and initiative when performing medical record audits. Performs all work duties and responsibilities with minimal supervision. Communicates identified quality or risk issues through departmental and hospital chain-of-command.
6. Supports hospital-wide patient safety, performance improvement, and data management /analysis functions through participation and support of interdisciplinary and intradisciplinary activities to maximize outcomes utilizing minimum resources. Able to work with hospital employees and Medical Staff towards improving internal and external quality indicators.
7. Projects a positive customer service image and responds effectively when dealing with patients, family members, staff, physician, and other departments by integrating I CARE values into operational milieu.
8. Ensures the department facilities are maintained in proper condition and that basic environmental safety standards are met. Ensures departmental employee compliance with the hospital safety program.
9. Performs other duties as assigned in a professional, cooperative, and responsible manner reflecting positively on the department leadership noted in the Houston Methodist St. John Hospital organizational chart.
10. Exhibits expected behaviors for patient and visitor interactions as outlined in the Service Pride program.
* Graduation from an accredited School of Nursing.
* Current license to practice as a Registered Nurse in the State of Texas.
* BSN preferred.
* Minimum of 2 years of recent acute care hospital experience required.
* 1 to 3 years` quality or utilization review background preferred.
* Knowledge of process improvement strategies and statistical methods preferred.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
* Current license to practice as an RN in the State of Texas.
* BLS for healthcare providers.
* CPHQ preferred.
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
* Knowledge of quality or utilization review and principles required.
* Good oral and written communication skills.
Equal Employment Opportunity
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor priority referral Protected Veterans requested.