RN , Quality Peer Review Specialist

Peer Review Specialist

With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years. As a proud member of Trinity Health, one of the nation's largest Catholic healthcare delivery systems, our network of caring spans 22 states, 94 hospitals, and 133,000 colleagues nationwide.

We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

What we offer:

• Competitive compensation and benefits packages including medical, dental, and vision coverage
• Retirement savings account with employer match starting on day one
• Generous paid time off programs
• Employee recognition incentive program
• Tuition/professional development reimbursement
• Relocation assistance (geographic restrictions apply)
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing
• Mount Carmel offers DailyPay - if you're hired as an eligible colleague, you'll be able to see how much you've made every day and transfer your money any time before payday. You deserve to get paid every day!

The Peer Review Specialist provides leadership and coordination for the provider peer review processes across the facilities and service areas within Mount Carmel Health System and affiliate joint venture businesses as assigned.

Responsibilities

• Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service. Meets population specific and all other competencies according to department requirements.
• Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients.
• Relationship-based Care: Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system.
• Steward human and financial resources in a responsible manner.
• Facilitates the provider peer review process including case identification through internal reporting data, registries, or the incident reporting system based on defined indicator criteria. Writes case summaries for cases that meet the peer review indicator list and sends them to physician reviewers for further evaluation.
• Leads provider peer review committee meetings in partnership with the committee chair ensuring timely and effective case discussion and resolution.
• Onboards new peer review committee members and department chairs, providing education on peer review responsibilities and Ongoing Professional Practice Evaluation (OPPE) requirements.
• Tracks and analyzes peer review trends, escalating system-level concerns as appropriate.
• Drafts provider communications based on peer review needs.
• Maintains provider files with all peer review-related documentation and communications.
• Partners with the legal team to ensure peer review processes and documentation meet compliance and risk standards. Prepares and presents executive-level summaries and reports related to peer review findings and provider performance.
• Reviews peer review committee charters and policies and facilitates updates with approval from the Medical Executive Committee when needed.
• Maintains current knowledge of regulatory and accrediting requirements relevant to peer review and OPPE.
• Collaborates with department chairs to complete OPPE documentation in alignment with regulatory standards and internal policies.
• Attends Joint Commission or other regulatory meetings related to medical staff review of OPPE.
• Maintains confidentiality of all peer review and OPPE-related communications, documentation, or processes in accordance with regulatory and organizational standards.
• Audits peer review and OPPE processes to ensure adherence to established protocols while identifying potential gaps.
• Communicates identified system-level issues arising during the peer review process to the appropriate team for follow-up and resolution.
• Travel to various sites as required.

Requirements/Qualifications

• Education: Baccalaureate Degree in Nursing required. Masters in Nursing preferred.
• License / Certification: Current license to practice as Registered Nurse in the State of Ohio.
• Experience: Minimum of five (5) years recent hospital practice. Clinical and management experience preferred.
• Effective Communication Skills
• Current knowledge of regulatory and accrediting requirements
• Proficient computer skills
• Able to prepare and present executive level summaries and presentations

Discovering opportunities, support and excellence all while making a real difference in patients' lives begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.