The University of Illinois Hospital & Clinics (UI Health) is seeking a Physician Excellence RN Case Reviewer.  The Physician Excellence RN Case Reviewer provides leadership and applies clinical knowledge to assure the Medical Staff Peer Review process and the Physician Excellence & Recognition Review Committee is effective in evaluating issues related to professional practice. The RN Case Reviewer develops accurate clinical case summaries, data trending, reports and analysis for Medical Staff Leadership and the Review Committee consistent with guidelines established by the Medical Staff departments and regulatory agencies. This position is responsible for overall management of the physician peer review clinical review process including, tracking committee recommendations and follow-up actions for timeliness of response. The RN Case Review assists the Senior Director and Medical Staff Leadership with physician performance initiatives and coordinates clinical and non-clinical performance improvement in compliance with organizational goals and regulatory standards.

• Under the direction of the Senior Director, coordinates the Medical Staff peer review process which entails the review of and analysis of medical records, data collection, aggregation and analysis.
• Applies clinical knowledge to screening criteria to identify cases meeting criteria and those requiring further analysis through assessment of information from various data systems. Coordinates and communicates with Department and Medical Staff committee membership to assure consistent screening and scoring presentation of select cases for peer review.
• Attends Medical Staff Peer Review Committees and serves as a liaison between various committees to facilitate communication and referral of cases for further physician review, and report results back to referring committee.
• Assists with preparation of monthly Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice clinical metrics and collaborates with appropriate Medical Staff Services Departments and Leaders for activities related to professional practice evaluation and peer review.
• Oversees that peer review data is entered in appropriate database in a timely and accurate manner. Coordinates with Senior Director and Clinical Analyst to generate associated reports for Chiefs of Service, designated Medical Staff and Hospital Committees and Medical Staff leadership.
• Initiates follow-up planning processes and activities and collaborates with staff with hospital and medical departments as needed. Manages information and supports medical staff leadership to assure accountability for follow-up responsibilities. Creates charts and graphs for facilitate the communication of data and trends.
• Maintains knowledge of The Joint Commission and Centers for Medicare and Medicaid Services requirements pertaining to the medical staff peer review process.
• Maintains working knowledge of the University of Illinois Medical Staff Bylaws, Rules and Regulations and associated policies.
• Assures compliance with ongoing process for archival of Physician Excellence and Recognition Review Committee peer review related minutes, documents, policies and files to mitigate legal and regulatory risk.
• Documents all steps of medical staff peer review committee management, including minutes and letter generation, tracking action items, action plan follow-up and resolution.
• Perform other related duties and participate in special projects as assigned

• Bachelor's degree in Nursing from an accredited school of professional nursing required. Master’s degree preferred.
• Minimum five (5) years of professional nursing in an acute care, hospital-based clinical experience required.
• Current/Active Illinois RN license required.
• Demonstrated knowledge of principals related defining quality of care, medical standards and clinical indicators required.
• Demonstrated ability to operate a personal computer and standard office equipment and proficiency in Microsoft Word required.
• Advanced proficiency in Microsoft Office software (Microsoft Word, Excel, PowerPoint, and e-mail) preferred
• Certified Professional in Healthcare Quality (CPHQ) preferred
• Previous experience working in one or all of the following areas: quality care management; medical staff peer review, OPPE and FPPE preferred
• Experience working in an academic medical center preferred.
• Strong organizational, problem solving and analytical skills and the ability to make independent decisions.
• Knowledge of clinical quality and operational process improvement.
• Strong interpersonal skills that reflect professional competence, courtesy, and respect towards others and are able to work effectively with staff, physicians, and leadership.