Quality Review Specialist-RN

Risk Management  
Full Time
Day Shift 
Day Shift

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #2 in the state and #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina.

The 607-bed teaching hospital anchors a health care network that includes five community medical centers and employs more than 8,000 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices.  Its postgraduate medical education programs include family medicine and transitional year.

 

 

 

 

Job Summary

The Quality Review Specialist-RN provides consultative services regarding quality assessment and trends to medical staff and to hospital ancillary department personnel. In this role, the employee will perform comprehensive retrospective reviews in a timely manner utilizing criteria developed and approved by the medical staff, hospital, and regulatory agents.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 4 Years of clinical or hospital experience; 2 Years of experience in quality or utilization review.
Substitutable Education & Experience (Optional): None.
Required Certifications/Licensure: Registered Nurse (RN)
Required Training: None.

Essential Functions

• Utilizes in-depth knowledge of clinical workflows, policies and procedures, patient care / clinical business processes, regulatory requirements, and best practices to:    
  • Risk Management-
    • Perform daily review of new occurrence reports.
    • Identify occurrences that require additional follow-up and reports these to the Director or designee in a timely manner.
    • Ensure that occurrences are categorized correctly and all fields completed and correct. Verifies data accuracy with medical record if necessary.
    • Ensure that occurrence reports are forwarded to all appropriate persons.
    • Access other sources of data as needed for investigation and follow up.
    • Serves as System Administrator for the occurrence reporting system.
    • Primary liaison between Risk Management, Information Services, and system users.
    • Manages access to the occurrence reporting system.
    • Adds new locations and new users and provides new-user training. Assigns passwords. Removes users as needed.
    • Provides new user training and ongoing user support, paying keen attention to user needs and opportunities to offer solutions and modify processes to improve efficiencies. 
    • Coordinates with vendor and Information Services to troubleshoot system as needed.                                             
  • Center for Best Practice & PN Quality-        
    • Assists with development, implementation, and evaluation of the hospital’s overall quality improvement program.
    • Assist with coordination, preparation, and maintenance of performance improvement assessment and improvement activities.
    • Responsible for data integrity and follows well defined processes for maintaining data integrity as well as manage assigned database.
    • Assists in evaluation, analysis, maintenance and development of system functionality of the EHR to meet clinical objectives including participating in project plan development/tracking and workflow analysis.

Duties & Responsibilities

• Provides accurate and timely routine statistical analyses and reports to designated parties. Identifies need for new reports and develops and creates reports. Generates user-friendly reports from other databases.
• Evaluates and analyzes data for trends, identifies areas of concern, and uses data display techniques to provide reports for various meetings and hospital committees.
• Prepares materials for meetings and assists with maintenance of performance improvement project records.
• Represents department on committees / teams as assigned. 
• Participates and supports department goals, objectives and timelines, working with a sense of urgency and accuracy to ensure effective implementation. Successfully engages in multiple initiatives simultaneously and demonstrates flexibility in role and a willingness to help others.
• Attains an annual minimum of 12 ho