RN Peer Review Analyst Qualtiy Review Full Time Days

PIH Health; Los Angeles (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

PIH Health seeks an RN Peer Review Analyst in Los Angeles to retrospectively review medical records, validate quality of care, and ensure documentation accuracy. You will audit charts for appropriate admissions and continued stay, collaborating with physicians and nurses to improve charting across care teams.

You will monitor hospital metrics, participate in team meetings, and support Medicare documentation strategies to enhance DRG assignment and compliance.

Qualifications

• Organizational, analytical, writing and interpersonal skills.
• Dependable and self directed.
• Critical thinking, problem solving and deductive reasoning skills.
• Basic computer skills – familiarity with Windows based software.
• Knowledge of Medicare Part A and B.
• Understanding of regulatory environment.
• Understanding and supporting documentation strategies.
• Understand and communicate Medicare requirements and how they impact DRG assignment.

Responsibilities

• Retrospective review of medical records for quality and accuracy.
• Audit charts for admission appropriateness and continued stay.
• Monitor compliance with hospital metrics and care documentation.
• Interact with physicians, nurses and professionals regarding charting.
• Participate in team meetings to improve charting for clinicians.

Skills

Organizational skills

Analytical skills

Writing skills

Interpersonal skills

Dependable

Self-directed

Critical thinking

Problem solving

Medicare Part A/B knowledge

Regulatory understanding

Documentation strategies

DRG assignment knowledge

Education

Current California RN license

RN degree or higher preferred

Bachelor/Master degree preferred

Job description

Responsible for the retrospective review of medical records and compiling data to validate quality of care, appropriateness of care , and accuracy of documentation. RN Peer Review Analyst will audit charts for appropriateness of admission, continued stay, compliance to hospital metrics and to monitor care provided by our caregivers. RN Peer Review Analyst will interact with physicians, nurses and other professionals regarding chart documentation and actively participate in team meetings to help improve charting for physicians and clinical staff. Case found not meeting approved guidelines will be selected for peer review and follow up.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Organizational, analytical, writing and interpersonal skills.
• Dependable and self directed.
• Critical thinking, problem solving and deductive reasoning skills.
• Basic computer skills – Familiarity with Windows based software programs.
• Knowledge of Medicare Part A and B.
• Understanding of regulatory environment.
• Understanding and supporting documentation strategies.
• Understand and communicate Medicare requirements and how they impact DRG assignment.

Required Experience

• LA City Fire Card within 6 months of employment
• Current California RN license

Preferred:

• RN Degree in Nursing, a Bachelor’s Degree or Master’s Degree preferred.
• Five years of clinical chart review, conducting chart aults and working in Quality Managment, Case Managment, ED or ICU

Qualifications:

SPECIFIC SKILLS NEEDED

• Organizational, analytical, writing and interpersonal skills.
• Dependable and self directed.
• Critical thinking, problem solving and deductive reasoning skills.
• Basic computer skills – Familiarity with Windows based software programs.
• Knowledge of Medicare Part A and B.
• Understanding of regulatory environment.
• Understanding and supporting documentation strategies.
• Understand and communicate Medicare requirements and how they impact DRG assignment.