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This position works under the direction of the CQM Medical Surgical Patient Safety Lead and CQM Manager. The individual in this role will focus on investigating medical and surgical potential quality issues / serious reportable events and utilization issues by conducting retrospective chart and focused reviews.
This is a office position working at 2222 W Dunlap Avenue, Phoenix, Arizona.
- Identifies potential quality issues (PQIs), and serious reportable events (SREs) by applying best practice standards of care and clinical experience
- Conducts timely reviews of electronic medical records to meet UHC M&V standards
- Investigations include research, analysis and preparation of written and verbal case summaries with recommendations for further actions as necessary
- Ability to organize and maintains current investigation information about cases through documentation in quality of care and quality of service databases
- Communicate in writing to health care providers
- Develops peer review cases and other quality improvement activities identified by deviations from accepted standards of care and monitors corrective action plans
- Assists with focused reviews by abstracting medical records for specified criteria
- Participates on quality committees and presents cases to peer review quality management committee
- Collaborates with Medical Directors on complex care identified in PQIs / SREs as needed
- Performs other duties as assigned