Care Review Resources Careers

This position is available for remote work from 20-40 hours a week.

Essential Job Outcomes & Functions:

• Conduct primary or secondary screening of patient care variances to identify those cases warranting physician review.
• Evaluate variance of monitoring functions to identify those meeting criteria for physician review (mortality, morbidity, blood usage, infection, adverse drug reactions, unusual occurrences).
• Initiate periodic physician review of screening criteria to validate currency, relevance and appropriateness.
• Coordinates statistical process review of selected diagnoses and procedures for medical staff review.
• Initiate referral process to the appropriate medical staff peer review group in coordination with medical staff coordinator:
• Prepare individual case referrals for physician review with appropriate supporting, background documentation.
• Work through medical staff coordinator to facilitate timely referrals, initiate measures to promote a thorough physician review with an objective outcome.
• Attend multidisciplinary medical staff peer review committee meetings as cases are presented and reviewed.
• Enter outcomes of physician peer review into appropriate software system.
• Provide summary reports to medical staff committees, as well as physician specific reports for credential committee and physician profiles.
• Liaison with Quality Department and External Payors as needed to orchestrate response to quality issues identified by external payors.
• Disseminate information in a timely manner to applicable individuals.
• Assist with continuous readiness activities.
• Consistently applies infection control policies/procedures.
• Meets population specific competencies.
• Attends department education/training in-services.
• Participates in specific performance improvement projects.
• Perform data management activities/documentation.
• Utilizes appropriate applications such as Crimson, MS Excel, MS Word, MS Outlook, etc.

Minimum Requirements / Work Experience:

• Minimum three years’ experience in acute hospital setting
• CA issued RN license required
• Previous UR/QA/QI/RM/Case Management experience required
• Knowledge of various agencies and regulations pertaining to TJC, CMS, CDPH, CCS, Medi-Cal, IMQ, etc.
• Minimum three years with computer applications/software Microsoft Office preferred
  • Word, Excel (intermediate level user), Outlook
• EMR Experience – EPIC (Inpatient and outpatient)

Care Review Resources, Inc has an immediate need for 2 on-site RN’s with relevant and recent experience in Peer Review for our client. Hours can be flexible. On-site initially, moving to remote once client is caught up. These are contractual positions; however, hours will be full-time initially.

Responsibilities

• Assist in getting caught up on entering and finishing hospital audits for OPPE: C-section, Hips and Knees, Bariatrics, CABG (we’ve 2019 complete), ED mortality, PEDs mortality, House mortality, Procedural sedation, PSI’s, H & P’s / Op reports from HIM and ATLAS reports for credentialing
• Review Core Measures fall outs
• Send follow up letters
• Enter data into MIDAS
• Teach and assist Client Responsibilities how to use ATLAS

Qualifications

• RN with current license
• 5+ years experience in Quality at hospitals
• Relevant and recent experience in Peer Review
• Pass complete background and drug screening, TB test
• Very Comfortable in MIDAS, CERNER, the OPPE, Peer review/FPPE process
• Knowledge of HIPAA compliance

Position Type: On-site
Location: Southbay, Los Angeles
Contract Duration: 1-3 months, Full-time

Key job functions:

• Oversees the facility’s patient safety program including updating the Patient Safety Plan
• Oversees Risk management activities
• Provide patient safety education at new hire orientation and for continuing improvement to all staff and leaders
• Identifies initiatives and programs to mitigate risks to reduce adverse patient outcomes, safer patient care and reduced costs.
• Ensure all accreditation and regulatory requirements for patient safety are fully met.
• Oversees event reporting, root cause analysis and event investigation and review
• Collect, analyze and report data on patient safety and risk events
• Receives and responds to patient complaints and grievances and works to resolve issues promptly
• Acts as intermediary among patients, staff and family to provide clear communications
• Coordinates claim requests and resolutions
• Prepares informative and actionable patient safety reports for presentation to appropriate committees and board of directors
• Oversee the coordination of all legal documents related to hospital liability.
• Assist with regulatory visits
• Assist with providing advice and guidance to the clinical staff and physicians of regulatory guidelines, reviewing policies and procedures

Risk Management experience requirements:

• Knowledge of processes, tools and techniques for assessing and controlling organization’s exposure to various kinds of risks
• Knowledge of risks that may affect patients in the health care environment.
• Knowledge of reporting agencies for patient safety issues and near miss incidents.
• Knowledge of federal, state, and local healthcare agency laws and regulations related to risk management and patient safety

Qualifications:

• Minimum of a valid RN or LVN license. Bachelor’s degree in nursing or related job/industry experience preferred.
• Minimum of three years or risk management, patient safety officer experience.
• Ability to work collaboratively with other members of the health care team, patients and families