Peer Review Program Manager

Paycom - ATS; United States; Hybrid; USD 81,000 - 121,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision care

Life insurance

LTD/ADD

Job summary

Washington Hospital Services seeks a Peer Review Program Manager to administer policies and initiatives within the Peer Review program, ensuring CMS CAH standards and maintaining high client service. The role requires HIPAA compliance oversight, coordination with Compliance and IT, and collaboration with hospitals and physicians to advance program goals and measure success.

Candidates with healthcare quality improvement knowledge and strong communication skills will thrive in a hybrid office

Qualifications

• 3 years of related experience in peer review, credentialing, or healthcare program management.
• Bachelor’s degree preferred or equivalent experience in healthcare administration or related field.

Responsibilities

• Administer all aspects of the Peer Review Program.
• Ensure CMA/CAH standards compliance in peer review processes.
• Maintain HIPAA privacy training and monitor physician/hospital compliance.
• Coordinate with Compliance and IT to keep processes updated.
• Communicate with hospital clients and Peer Review clinicians on progress.
• Support marketing and client outreach for the program.
• Track metrics and report program success to senior leadership.

Skills

HIPAA compliance

Healthcare quality improvement

Relationship building

Communication

Multi-tasking

Problem solving

Microsoft Office

Adobe Acrobat

Education

Bachelor’s degree preferred

Equivalent experience

Tools

Adobe Acrobat

Job description

Job Title: Peer Review Program ManagerDepartment: Washington Hospital ServicesReports to: President, WHSHybrid Work OpportunitySalary: $80,988-$121,482The hiring range for this position is generally centered below the midpoint of the posted salary range. Placement within the range will depend on qualifications, experience, demonstrated capabilities, and internal equity considerations.Benefits:Medical, Dental, Vision, Life, LTD, ADD, Supplemental Life and ADD, FSA (Dependent/Health), Safe Harbor 401K with Match, Vacation 2-4 weeks, End of year Wellness Week from 12/25 and 1/2, 9 Holidays, 2 Personal Holidays, EAP, and Transportation Assistance.Position Summary:The Peer Review Program Manager is responsible for administering key policies, programs, and initiatives related to the Peer Review program.Essential Duties and Responsibilities:Administer all aspects of the Peer Review Program.Administer all aspects of the physician peer review process required to meet standards of participation for continuing Center for Medicare and Medicaid Services (CMS) critical access hospital (CAH) status.Maintain the highest level of customer service for inquiries related to Peer Review.Understand and follow all HIPAA privacy regulations regarding the transfer of personal health information, including participation in HIPAA training, and monitoring physician and hospital compliance with HIPAA regulations as they interact with the program.Understand and follow the program requirements for maintaining discovery protections under the federal Patient Safety Organization (PSO) structure, Washington state Coordinated Quality Improvement Program structure (CQIP), and applicable laws of any other states in which the program is operating. Work with WSHA’s Director of Compliance and Senior IT Solutions Architect to ensure processes and procedures remain up to date.In coordination with the President, propose and support the development and implementation of strategies to improve, make more efficient, and/or grow the Peer Review program.Provide regular updates to President and other senior leaders regarding the Peer Review program, including customer satisfaction.Communicate regularly and effectively with hospital clients and Peer Review clinicians to schedule and monitor progress of peer reviews regularly.Facilitate communication with the WSHA patient safety program and other relevant constituencies to ensure smooth operational flow.Support the development and execution of marketing the Peer Review program to current and future customers.Manage and cultivate strong relationships with contracted clinicians and support the ongoing recruitment of clinicians to participate in the program.Support the development of quarterly meetings for Peer Review clinicians to promote best practices and standardization.Work with the Chief Medical Advisor, WSHA Senior Vice President for Safety and Quality, and WHS President to support the development and tracking of metrics for measuring and reporting programming success.Partner with the Senior IT Solutions Architect and IT staff to proactively support the building and maintenance of the technical systems supporting the Peer Review Program.Work with the Director of Compliance and Contracts by providing program information and materials necessary for contract development and review, evaluation of state-specific peer review requirements, implementation of CQIP and PSO protections, and ongoing compliance with applicable federal and state laws governing peer review activities.Supervisory Responsibilities:This position does not have supervisory responsibilities.Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and have a strong desire to learn new skills on an ongoing basis. The requirements listed below are representative of the knowledge, skill, and/or ability required.Education/Experience:3 years of related experience supporting peer review, medical staff credentialing, compliance, or other program management in healthcare that includes working with physicians and/or senior healthcare executives. Bachelor’s degree preferred or equivalent combination of education and experience.Skills & Abilities:Knowledge of federal, state, and local healthcare quality improvement processesKnowledge of HIPAASkill in developing and maintaining effective working relationships with client staff including facility CEOs, CNOs, quality leaders, physicians, infection prevention staff, and public officialsSkill in developing and maintaining effective working relationships with other staff members at hospitalsAbility to organize, prioritize and multi-task on a wide variety of projects and tasksExercise sound judgment and maintain confidentiality as needed in all aspects of the programProficient in internet researchStrong organizational and communication skills (writing, speaking, and listening)Excellent problem-solving skillsExcellent customer service skillsComfortable giving and receiving feedback in a constructive manner to colleagues and supervisorsComputer Skills:Proficiency with computers and software is required, including Microsoft Office Suite (Outlook, Word, Excel, Teams, OneDrive, SharePoint and PowerPoint).Experience with Adobe Acrobat is a plus.Comfort with technology in generalPhysical Demands & Work Environment:The physical demands and work environment described here represent those typically encountered in this position. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.This position is typically performed in an office environment with a moderate noise level and the use of standard office equipment such as computers, phones, and copiers. The role requires clear communication in person, over the phone, and in writing, as well as the ability to review and respond to documents in electronic and paper formats.