RN Professional Practice Quality Reviewer (Full Time, Days)

Job Summary

The RN Professional Practice Quality Reviewer is responsible for overseeing the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes to ensure compliance with regulatory standards, supports credentialing, and promotes high-quality patient care. Collaborates with medical staff, hospital leadership, and quality assurance teams to monitor practitioner performance and maintain accreditation requirements.

Job Specific Duties

• Conducts clinical reviews using sources ranging from medical records, incident reports, best practice guidelines & interviews in an effort to monitor quality performance & identify improvement opportunities.
• Works in collaboration with Quality Improvement Analyst to prepare performance metrics and quality reports to various departments and medical staff.
• Prepares quantitative data, reports, and presentations for committees and individuals.
• Attends and participates in committees supporting ongoing quality improvement initiatives, which may include preparing agendas and recording meeting minutes.
• In collaboration with the Quality Department and Medical Staff Administration, prepares professional practice reviews for physician reviewer.
• Responsible for quality review activities that include evaluation and processing of data including; trending, tracking, and monitoring.
• Participates in national collaborative efforts and initiatives, which includes data abstraction and entry, and presentations of summary reports produced through the collaborative.
• Communicates with a variety of clinical disciplines and physician advisors to clarify criteria and summaries.
• Responsible for identifying potential risk and quality issues.
• Collaborates with data analytics and information technology as needed to optimize EMR integration for performance metrics.

Minimum Job Requirements

• Bachelor of Science in Nursing (BSN)
• RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) - maintain active and in good standing throughout employment
• 1-3 years of experience in healthcare quality
• 3-5 years of clinical nursing experience

Knowledge, Skills, and Abilities

• Ability to establish a positive working relationship and rapport with medical staff, department leaders, staff, and colleagues.
• Ability to prioritize work and evaluate workload in order to meet deadlines.
• Ability to interpret and extrapolate clinical information from review of various sources of material, primarily by mining the electronic medical record, and to draw conclusions about the quality of care provided.
• Ability to maintain confidentiality of protected health information and other sensitive information.
• Proficiency in Microsoft Office Suite Word, Outlook, Excel, and PowerPoint required; Access, Visio and SharePoint preferred.
• Demonstrates continuously improving professional growth and expertise through participation in relevant training and education.
• Excellent interpersonal communication and negotiation skills.
• Ability to communicate effectively both verbally and in writing.
• Strong analytical, data management, and computing skills.
• Reacts effectively to unplanned circumstances, demands, and challenges facing the hospital and in the particular assigned area of responsibility.