Registered Nurse (RN) Professional Practice Evaluation (PPE) Specialist
The RN Professional Practice Evaluation (PPE) Specialist provides process coordination and applies clinical knowledge to assure that the Professional Practice review process is effective in evaluating issues related to professional credentialing, conduct and practice.
Under the direction of Manager, coordinates the professional practice evaluation process which includes the review of and analysis of medical records, data collection, and aggregation/analysis.
Applies clinical knowledge to screening criteria to identify cases requiring further analysis through assessment of information from various data systems. Coordinates and communicates with Manager and Professional Practice Committee to assure consistent screening and scoring presentation of select cases for professional practice evaluation.
Coordinates and attends the Professional Practice Committee and serves as a liaison between various departments to facilitate communication and referral of cases for further review.
Coordinate and monitors provisional appointments.
Assists with preparation and coordination of the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) clinical metrics and collaborates with appropriate Departments and Leaders for activities related to professional conduct and practice evaluation.
Oversees that peer review data is entered in appropriate database in a timely and accurate manner.
Generates associated reports for designated Professional Staff committees and leadership.
Manages data quality and integrity based on defined standards through systematic audits.
Maintains knowledge of The Joint Commission and Centers for Medicare and Medicaid Services requirements pertaining to the professional practice processes.
Maintains a working knowledge Medical Staff Bylaws, Rules and Regulations, Credentialing Policy and other professional staff policies.
Documents all steps of the professional conduct and practice evaluation process including minutes and letter generation, tracking action items, action plan follow-up and resolution.
Utilizes discretion and maintains confidential, sensitive provider professional practice information; uses appropriate safeguards to prevent inappropriate use or disclosure of confidential peer review information.
Functions as an agent of the protected peer review process.
Assists the credentialing staff with the interpretation of privilege requests, when needed.
Monitors appropriate privileging requirements of care delivered by practitioners.
Adheres to organizational and department-specific safety standards and guidelines.
Adheres to TMC values of integrity, diversity, accountability, compassion, and teamwork.
Performs related duties as assigned.
EDUCATION: Graduation from a qualified, nationally-accredited nursing program required. Bachelor’s degree preferred.
EXPERIENCE: Four (4) years RN nursing experience, preferably in an acute care setting.
LICENSURE OR CERTIFICATION: Current RN licensure permitting work in the State of Arizona required. Current NAMSS CPCS certification preferred.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of nursing and patient care best practices.
Skill in evaluating cases and determining correct processes and training others to ensure maximum effectiveness.
Ability to read, analyze, and interpret medical periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to inquiries or complaints from employees, physicians, patients and/or their representatives, and the general public.
Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.
Ability to define problems, collect data, establish facts, and draw valid conclusions; ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Ability to recognize areas of need, and recommend and implement strategies for improvement.