Job Description

Job Description

Job Description

POSITION SUMMARY

The Core Abstraction Peer Reviewer reports to the Quality Director and is responsible for core measure data abstraction, analysis, and reporting, while supporting the organization's peer review processes. This role combines clinical expertise with quality data management to ensure accurate core measure compliance and facilitate physician peer review activities. The position requires participation in performance improvement initiatives and maintenance of regulatory compliance standards.

Basic Qualifications: Licensed as a Registered Nurse in the state of California, Bachelor of Nursing degree. Possesses excellent oral, written and communication skills. Familiar with Accreditation Regulatory Standards, CDPH Title 22, CMS Conditions of Participation and Other Regulatory Standards.

ESSENTIAL FUNCTIONS

1. Core Measures Management

1. Abstract core measure data with high accuracy and input into quality system (Midas)
2. Review core measure documentation and identify opportunities for improvement
3. Develop action plans for core measure improvement in collaboration with clinical teams
4. Assist core measure abstractors with formulating comprehensive reports
5. Communicate changes in abstraction guidelines to core measure team leaders and clinical staff
6. Monitor core measure performance trends and provide data-driven recommendations

2. Peer Review Support

1. Participate in the medical staff peer review process by:
2. Identifying and screening potential quality of care issues
3. Determining if cases meet inclusion or exclusion criteria for physician level review
4. Entering case synopsis in Quality Management (QM) Module
5. Documenting Committee findings in QM Module
6. Attending physician meetings as requested
7. Act as liaison between physicians and process improvement teams
8. Assist Risk Management in peer review processes

3. Physician Quality Profile Development

1. Collaborate with Medical Staff providers to develop provider quality profiles for OPPE by:
   i. Creating approved provider profiles using core measure data
   ii. Running provider reports with focus on core measure performance
   iii. Validating provider metrics for accuracy and completeness
   iv. Facilitating development and reporting of physician quality data in various modalities

4. Performance Improvement

1. Participate on at least one Performance Improvement (PI) team
2. Facilitate PI project development and reporting related to core measures
3. Provide education regarding core measures and PI to individuals and/or teams as required
4. Collaborate with multidisciplinary improvement teams

5. Quality Data Analysis and Reporting

1. Monitor Quality Review Reports and facilitate corrective actions
2. Facilitate reporting to leadership and departments regarding core measure performance
3. Utilize assistive software, literature, and manuals
4. Participate in Quality Net and California Hospital Patient Safety Organization activities

7. Committee Participation

a. Attend and participate in committees or meetings as requested
b. Serve as effective member in meetings with frontline staff, leaders, and administration
c. Inform, motivate, and problem-solve regarding core measure initiatives

8. Other duties as assigned

EDUCATION & EXPERIENCE

1. Current CPR certification
2. Licensed by Board of Registered Nurses in the State of California
3. Bachelor of Science Degree in Nursing or comparable
4. Extensive job knowledge in nursing, medical staff, and patient care services, as well as administrative practice
5. Minimum of 3 years clinical experience
6. Experience with core measure abstraction preferred

SKILLS & ABILITIES

1. Lead and facilitate teams effectively
2. Proficiency in computer software programs: Word, Excel, Email, PowerPoint, and internet/intranet
3. Knowledge of Midas, Cerner, Allscripts ED, and Affinity systems
4. Comprehensive knowledge of DNV NIAHO Standards, Title 22, Conditions of Participation, and ISO 9001-2008
5. Strong analytical problem-solving skills using a systems approach
6. Excellent skills in professional writing, interpersonal communications, and negotiations
7. Superior organizational skills to manage time efficiently and handle multiple priorities
8. Ability to interact effectively with all customers, including physicians, staff, patients, visitors, and surveyors
9. Maintain calm and professional demeanor in all situations, including public interactions
10. Attention to detail and accuracy in data abstraction and analysis
11. Understanding of clinical workflows and documentation requirements

PHYSICAL REQUIREMENTS

1. Visual and hearing acuity pertinent to communicating with customers
2. Must be able to sit for long periods of time
3. Ability to review and analyze detailed medical records and documentation

SCHEDULING AND AVAILABILITY

1. 40 hours per week, generally regular hours are Monday through Friday, from 8:00 AM to 5:00 PM
2. Some flexibility expected when major organizational projects are underway
3. Available to respond to emergency situations
4. Occasional extended hours during regulatory surveys or accreditation visits

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