The Quality Management Coordinator coordinates Performance Improvement Activities for hospital key quality indicators and peer review activities, including but not limited to case reviews, case summaries, coordination of peer review completion, assistance with presentations as needed at applicable Medical Staff Committee meetings, maintenance of physician specific quality files for OPPE and FPPE, and required data submission to CMS, The Joint Commission and other outside organizations.

Serves as the Core Measurers Abstractor and Expert on Qnet, CMS Core Measures, Joint Commission and other clinical data sharing processes performed in the facility.|Performs, and is accountable for, Medical Staff Peer Review processes, including case review summaries and findings, conclusions (utilizing the Case Review Rating System approved by Medical Staff Organization), and action plans.|Integrates information and action from Medical Staff department reviews, as well as required function measurements, to maintain current physician profiles and Ongoing Professional Practice Evaluation (OPPE) tracking and documentation.|Participates in and supports the hospital and departmental Performance Improvement Program activities, including but not limited to data collection, data analysis, development of solutions, patient experience, prevention of hospital acquired patient harm/conditions, utilizing current evidence-based practices, supporting the Risk Management Program by referring cases with liability potential, etc.|Generates reports for individual Medical Staff Departments and required functions (i.e. Mortality & Autopsy, Core Measure Results, etc.) utilizing QM Director approved report formats which display the use of aggregate trended.|Demonstrates customer service behaviors according to hospital standards, including but not limited to excellent phone etiquette, acknowledging patients and their families, contributes to the team effort, meet or exceed the needs of internal and external customers, etc. Demonstrates responsibility in Professional Growth and Development, participates in in-service education, professional organizations, self-directed in assessing strengths/weaknesses in identifying career and self-development activities.