Quality Review Specialist-RN

Quality Management - Acute
Full Time
Day Shift
8:00-4:30

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state's first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer's care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

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 hours of continuing education in topics related to role.
• May prepare materials for meetings and assists with maintenance of performance improvement project records.
• May represent department on committees / teams as assigned.
• Risk Management:
  • Resolves problems and recommends solutions through research, inquiry, and data analysis, maintaining support call logs and tracking of issues.
  • Compiles and maintains accurate statistics pertaining to occurrence data.
  • Participates in and contributes to patient safety / risk reduction activities, including:
    • Participates in and contributes to investigations of serious unanticipated events and "close-calls".
    • Participates in and contributes to development, implementation and evaluation of corrective action plans.
    • Supports a culture of safety by encouraging staff to speak up and report safety and quality issues.
• Center for Best Practice & PN Quality:
  • Identifies opportunities for improvement and coordinates/participates in the development and implementation of action plans to make improvements- recommends changes to systems/processes that do not contribute to desired outcomes.
  • Works collaboratively and communicates effectively with administration, IS, and clinical care teams through participation in the planning, development, and evaluation and maintenance of the Clinical Information system.
  • Audits database contents for accuracy and validity.
  • Acts as a resource person in quality assessment activities with hospital departments and committees.
  • Works directly with hospital personnel to provide assistance and guidance in establishing criteria, reviewing medical records, etc.
  • Requires efficient use of numerous software products (Word, Excel, PowerPoint, Outlook, etc.)
• Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our benefit eligible employees and their families:

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.