Medical Staff Peer Review & Facility Enrollment Coordinator (FT, 100%)-Days

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    "ExternalDescriptionStr": "<p>Position Summary:<br>In the role of Medical Staff Peer Review Coordinator and Facility Enrollment, this individual is&nbsp;<br>responsible for coordinating and facilitating the medical and allied health staff peer review process to&nbsp;<br>ensure quality, safety, and adherence to regulatory standards. Manages and coordinates the FPPE&nbsp;<br>(Focused Professional Practice Evaluation) and OPPE (Ongoing Professional Practice Evaluation)&nbsp;<br>processes for both physician and advance practice professionals. This role involves organizing review&nbsp;<br>activities, maintaining documentation, and supporting medical staff in continuous quality improvement&nbsp;<br>efforts. This role facilitates the evaluation of practitioner competence, supports quality improvement&nbsp;<br>initiatives, and maintains accurate documentation of professional practice assessments. In the role of&nbsp;<br>Facility Enrollment Specialist, this individual is responsible for managing the enrollment processes for&nbsp;<br>the hospital’s and facilities within the organization. This role ensures that all entities are properly&nbsp;<br>enrolled with insurance payers, government programs and other relevant entities, allowing Adena&nbsp;<br>Health to deliver services and receive reimbursement in a timely manner.&nbsp;<br>Minimum Qualifications<br><strong>Required Educational Degree: </strong>Bachelor’s degree in healthcare administration, nursing, or related field<br>Major/Area of Concentration:<br>Preferred Education:<br>Required Certifications, Credentials and Licenses:<br>Preferred Certifications, Credentials and Licenses: Certified Peer Reviewer<br><strong>Required Experience:</strong> 5 years in acute hospital setting<br>Preferred Experience: 2-3 years of Peer Review, Quality, Patient Safety and Facility Enrollment</p><p><br><strong>Job Specific Knowledge, Skills &amp; Abilities</strong><br>Knowledge of medical staff processes, healthcare quality assurance, and regulatory standards. Strong&nbsp;<br>organizational and communication skills. Ability to handle sensitive information with discretion.<br>Experience with healthcare documentation and data management systems. Experience in medical staff&nbsp;<br>services, credentialing, or quality improvement. Knowledge of accreditation standards (e.g., The Joint&nbsp;<br>Commission), regulatory requirements, and healthcare quality metrics. Strong organizational, analytical,&nbsp;<br>and communication skills. Attention to detail and ability to manage multiple priorities. Familiarity with&nbsp;<br>healthcare data management systems and credentialing software. Excellent interpersonal and&nbsp;<br>collaboration skills.<br>Ability to interpret and apply complex regulatory standards. Discretion and confidentiality in handling&nbsp;<br>sensitive information.<br><strong>Job Specific Essential Functions</strong><br>• Peer Review: Coordinate the peer review process for medical staff, including scheduling,&nbsp;<br>communication, and documentation. Collect, organize, and maintain peer review data, reports,&nbsp;<br>and related records in compliance with hospital policies and regulatory requirements. Assist&nbsp;<br>medical staff and reviewers with the review process, ensuring timely and thorough assessments.&nbsp;<br>Facilitate communication among medical staff, hospital administration, and review committees.&nbsp;<br>Prepare summaries, reports, and follow-up documentation related to peer review activities.<br>• FPPE/OPPE: Analyze and compare initial privilege requests to clinical benchmark criteria.&nbsp;<br>Oversee the implementation and ongoing administration of FPPE and OPPE programs.&nbsp;<br>Coordinate the collection, review, and documentation of practitioner performance data. Ensure&nbsp;<br>timely completion of FPPE when practitioners are initially credentialed or after renewal. Monitor&nbsp;<br>and facilitate OPPE activities for ongoing performance evaluation. Gather data from various&nbsp;<br>sources such as peer reviews, patient outcomes, incident reports, and other quality metrics.&nbsp;<br>Analyze practitioner performance data to identify trends and areas for improvement. Prepare&nbsp;<br>reports for medical staff leadership and hospital administration. Act as a liaison between&nbsp;<br>medical staff, quality improvement, credentialing, and administrative departments. Educate&nbsp;<br>physicians and providers on FPPE and OPPE processes and requirements. Facilitate&nbsp;<br>communication regarding performance concerns and improvement plans. Ensure confidentiality&nbsp;<br>and integrity of peer review information. Support compliance with accreditation standards and&nbsp;<br>hospital policies regarding quality assurance and peer review. Assist in the development and&nbsp;<br>implementation of policies and procedures related to peer review. Provide education and&nbsp;<br>support to medical staff regarding peer review processes and expectations. Stay current with&nbsp;<br>relevant regulations, standards, and best practices related to peer review and quality assurance.&nbsp;<br>Ensure all FPPE and OPPE activities align with Joint Commission standards, state regulations, and&nbsp;<br>hospital policies. Maintain documentation to support accreditation and licensing audits.<br>• Facility Enrollment: Prepare and submit enrollment applications. Maintain accurate entity&nbsp;<br>records. Track application statuses, and resolve any issues that may arise during the enrollment&nbsp;<br>process. Ensure compliance with all relevant regulations and payer requirements. Assist with&nbsp;<br>periodic audits of provider files, ongoing compliance requirements for delegated credentialing.&nbsp;<br>Administrator and Primary Contact for with payers and entities related to facility enrollment. i.e:&nbsp;<br>UHC portal, IHD-Medicaid, etc.<br>• Software: Administrator, SME, and Liaison with Symplr- DataVision and StatIT, Cactus- Peer&nbsp;<br>Review or other software identified for Peer Review, FPPE, or OPPE in the future.</p>",
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