Physician Excellence Nurse Case Reviewer

Physician Excellence Nurse Case Reviewer

Hiring Department: Medical Staff Services

Location:  Chicago, IL USA

Requisition ID: 1024036

Posting Close Date: 3/29/2024

Salary Range: $110,000-145,000 Commensurate with experience

About UI Health

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois at Chicago (UIC), UI Health comprises a clinical enterprise that includes a 495-bed tertiary care hospital, 22 outpatient clinics, and 13 Mile Square Health Center facilities, which are Federally Qualified Health Centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

Position Summary

The Physician Excellence Nurse Case Reviewer provides leadership and applies clinical knowledge to assure the Medical Staff Peer Review process and the Peer and Exemplary Review Committee (Committee) is effective in evaluating issues related to physician clinical practice at the University of Illinois Hospital and Clinics. The Nurse Case Reviewer develops accurate clinical case summaries, data trending, reports and analysis for Medical Staff Leadership and the Committee consistent with guidelines established by the Medical Staff and regulatory agencies. This position is responsible for overall management of the physician peer review clinical review process including tracking committee recommendations and follow-up actions for timeliness of response. The Nurse Case Review assists Physician Excellence and Medical Staff Leadership with physician performance initiatives and coordinates performance improvement in compliance with Medical Staff Organization documents and regulatory standards.

Duties & Responsibilities

• Coordinate the Medical Staff peer review process which entails the comprehensive collection, review, analysis and aggregation of medical record data, including but not limited to diagnostic tests, treatment plans, and outcomes to evaluate the quality of care provided and identify areas for improvement.
• Apply clinical knowledge to consistently and fairly screen cases for peer review based on established review indicators, rules, and rates, ensuring alignment with organizational goals and quality improvement initiatives.
• Assign cases to physician reviewers according to their expertise and availability, maintaining a fair and equitable distribution of workload.
• Assist physician reviewers throughout the review process by providing necessary support, guidance, and resources as needed.
• Establish questions for care providers when additional information is needed to complete the review, demonstrating a thorough understanding of the medical record documentation and terminology.
• Attend monthly Peer Review committee meeting.
• Analyze review findings and prepare concise, accurate summaries and recommendations for presentation to relevant stakeholders, including Medical Staff Leaders and the Peer Review committee.
• Initiate, support, document and maintain accountability for all follow-up planning and activities.
• Collaborate with interdisciplinary teams, including Medical Staff Leadership, physicians, nurses, and quality specialists to implement improvement plans and interventions based on review outcomes; collects and monitors data required as part of improvement plans.
• Identify systems issues and refers to appropriate area for follow up.
• Serve as a liaison between the Peer Review committee, Physician Excellence department, Clinical Departments of the Health Colleges and Medical Staff and Hospital leadership for activities and requests related to Peer Review.
• Maintain meticulous documentation of case review activities, ensuring compliance with regulatory requirements and Medical Staff Organizational Documents; including ensuring peer review data is entered in appropriate database in a timely and accurate manner.
• Assure ongoing compliance for documentation and archival of peer review minutes, documents, policies and files to mitigate legal and regulatory risk.
• Maintain knowledge of evidence-based, clinical metrics, industry standards, guidelines, and best practices related to peer review, quality improvement, and patient safety; including The Joint Commission and Centers for Medicare and Medicaid Services requirements pertaining to Medical Staff peer review processes.
• Coordinate with Physician Excellence Leadership and Clinical Analyst to generate associated reports for Chiefs of Service, designated Medical Staff and Hospital Committees and Medical Staff leadership, including charts and graphs to facilitate the communication of data and trends.
• Perform other duties and participate in special projects related to peer review as assigned.

Minimum Qualifications

• Bachelor's degree in Nursing from an accredited school of professional nursing required.
• Minimum five (5) years of professional nursing in an acute care, hospital-based clinical experience required.
• Current/Active Illinois RN license required.
• Demonstrated knowledge of principals related defining quality of care, medical standards and clinical indicators required.
• Demonstrated ability to operate a personal computer and standard office equipment and proficiency in Microsoft Word required.

Preferred Qualifications

• Advanced proficiency in Microsoft Office software (Microsoft Word, Excel, PowerPoint, and e-mail) preferred.
• Masters in Nursing, Business or related field preferred.
• Certified Professional in Healthcare Quality (CPHQ) preferred.
• Previous experience working in one or all of the following areas: quality care management; medical staff peer review, OPPE and FPPE preferred.
• Experience working in an academic medical center preferred.

This is a full-time and benefits eligible position.  UI Health offers competitive salaries commensurate with experience.  All full time benefits eligible positions include a comprehensive benefits package which include; Health, Dental, Vision, Life, Disability & AD&D insurance, a defined benefit pension plan as well as paid leave which includes; Vacation, Holiday and Sick. In addition, we offer tuition waivers for employees and dependents. Go to https://www.hr.uillinois.edu/benefits for a complete list of Employee Benefits.

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation