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Manager - Quality Peer Review - Full time

Macon, GA, United States
Job ID: 115732
Job Family: Professional Services
Status: Full Time
Shift: Day
Detailed Shift and Schedule: Typically ranges from 8am-7pm with flexibility to meet the needs of the organization.
Job Type: Regular
Department Name: 52031082943205-Accreditation


Job Summary:

The Peer Review Manager is the primary custodian of the Peer Review program for the credentialed Medical  Staff of AHN Medical Center. The Peer Review Manager is responsible for managing all Medical Staff Peer Review activities. The Peer Review Manager works closely with the Section Chiefs to ensure that the Peer Review process remains fair, consistent, timely, defensible, balanced, useful, ongoing, and effective. This position will also be responsible for the OPPE/FPPE program & Peer Review through oversight of the Quality Improvement Coordination for credentialed Medical Staff peer review.


Essential Functions:

Annual review of Peer Review policies, forms & section indicators.

Identification of Peer Review cases for Medical Center, Navicent Health.

Coordinates with Data Analyst to ensure appropriate flow of Peer Review data to STATIT.

Closes/trends cases that meet Section Chief's pre-determined criteria; Meets with or otherwise communicates with the Section Chiefs for the purpose of previewing cases prior to meetings.

Routes Peer Review cases to the appropriate committee or committees in a timely manner.

Abstracts case information and enters cases into database system.

Notifies appropriate Section Chief, CMO, CNO and Directors of Medical Staff Services and Risk Management when Sentinel Events are identified during a review.

Reports aggregate-level Peer Review data to the Medical Executive Committee at least twice per year and to the Board of Directors annually.

Assigns physician reviewers as directed by Section Chiefs.

Notifies physicians of attribution and physician reviewers individually of cases that will be presented for review by the committee.

Prepares all documents for Peer Review Committee Meetings.

Functions in an advisory role during Peer Review Committee Meetings to ensure that the Peer Review Process is adhered to and Peer Review Privilege is protected.

Maintains the continuity of a Peer Review Process for the entire Medical Staff including Physicians and Advanced Practice Providers.

Oversees all peer review conclusions and actions are entered into the appropriate database.

Completes follow up on referrals to other Peer Review Committees or referrals to ancillary departments for process or system issues identified. Responsible for follow up correspondence with physicians of attribution as required.

Conducts FPPEs for Cause at the direction of the Credentials Committee/MEC/Section Chief when trends specific to an individual practitioner are identified.

Works with the Medical Staff Office to ensure appropriate flow of Peer Review Data into OPPE for use at the time of credentialing.

Stays current on new Standards as released by oversight agencies.


Education, Experience and Training:

Bachelor’s degree required in health related field.

Five (5) years working experience in clinical, medical field of practice (e.g. RN, PT, OT, RT).   Two (2) years experience with medical staff peer review or credentialing.

Licensed as Registered Nurse with the State of Georgia or licensure in other clinical practice area.

Management or leadership experience preferred.

Must have excellent computer skills. Mastery of Excel is mandatory. Must have in-depth knowledge of data management, healthcare analytics, data standardization and data integration between clinical and non- clinical systems in supporting data requests.