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Risk Reviewer

Risk Reviewer

Job ID 
2017-1686
Location 
US-TX-Houston
Function 
Administrative
Employment Status 
Full-Time

More information about this job

Overview

Quality Case Reviewer

Responsibilities

  • Assist the Quality/Risk Director and medical staff in developing and maintaining a quality assessment and performance improvement program designed to measure individual and divisional performance using valid, reliable and measurable indicators. Identifies case selection and data collection methods. Using established peer review mechanisms analyzes cases for review, identifying opportunities for improvement, areas of potential risk and referring cases to appropriate committee/division for review and action.
  • Assist the Quality/Risk Director and medical staff in identifying areas of potential risk.   Identifies case selection via verbal or written communication, which are individually monitored and maintained in an automated tracking system (HIRO). Prepares and provides all written communication as required for CQI Committee activities, documenting conclusions, recommendations and actions taken to improve individual and divisional performance, maintaining an automated tracking system (Survey Vitals, QIC, MD Cloud and HIRO) to assist in trend identification, where appropriate, and to provide information at the time of recredentialing and reappointment.
  • Nurse Peer Review representative for nurse peer review committee. Responsible for identifying cases for review. Prepares and provides all verbal/written communication as required for Nurse Peer Review activities, documenting conclusions, recommendations and actions taken.
  • Assists the Risk/Quality Director in maintaining an automated tracking systems – Survey Vitals, QIC, MD Cloud/Risk database in HIRO for all incidents, claims and lawsuits.
  • Prepares and evaluates CQI/QMS reports on a quarterly basis for all sites. Discusses and updates facility based quality staff as needed.
  • Assists physicians and other Platforms with focused reviews as needed for hospital CQI activities from our QIC/MD Cloud data/Survey Vital Alerts and organize a CQI report for submission for all USAP Platforms as needed.
  • Requests and Pulls medical records needed to complete reviews for all USAP Platforms as needed.
  • Assists the Quality/Risk Directors of all USAP Platforms as needed with handling of patient complaints. Creates letters or contacts patients as needed in responses to complaints. Investigates incidents, claims and provides an accurate assessment of medical records for professional and general liability claims.
  • Assists with responding to Survey Vital Alerts requesting to be contacted for review of the issues brought up by the patient. Review records and contact patient to listen, discuss and assist in resolving any pending questions/issues.
  • Assists Director of Qualtiy/Risk Management and physicians with billing, coding issues and follow-up as needed internally.
  • Assists the Director of Quality/Risk and physicians with all other requests as indicated.

Qualifications

  • Licensed Registered Nurse, Chart Review Experience A +

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