Presbyterian Healthcare Services

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at Presbyterian Healthcare Services

Posted: 3/10/2020
Job Reference #: 12041
Keywords: medical

Job Description

Requisition ID
Location : Name
Presbyterian Hospital
Default: Location : City
Default: Location : State/Province (Full Name)
New Mexico


Responsible for Quality of Clinical Care activities. Coordinates the provider peer review process which assesses and reviews the quality of patient and member care provided by direct care providers and facilities. Investigates all complaints alleging inappropriate clinical care or alleged inappropriate behavior by a physician or other health care practitioner/provider. Applies the knowledge of a registered nurse to determine the key factors in each case and whether the standard of care has been met, documenting and summarizing findings for all parties regarding investigative findings. Collaborates with other staff including medical directors, registered nurses, and legal counsel.

Job Description
Type of Opportunity: Part Time (.45 to .89)
FTE: 0.700000
Exempt: Yes
Work Schedule: Days


  • Coordinates tracking and trending of data for QOC, reporting to appropriate internal committees and bodies as well as external agencies.
  • Collaborates closely with internal stakeholders.
  • Develops and refines processes, policies and procedures, and desktop tools. Supports implementation of change projects/initiatives. Supports the development and implementation of the department strategic plan.
  • Reviews, responds to, and researches complaints related to quality of medical care utilizing a high level of knowledge and skill in nursing practice in order to discern the key factors in each case to ensure that all quality of care issues are identified and addressed. Provides appropriate referrals to Legal/Risk Management for potential legal or at risk issues, Health Services Care Coordination for members at risk, and Provider Network Management for identified service issues.
  • Presents the facts of the case and makes recommendations to the Peer Review Committee for cases involving quality of care issues. Takes appropriate action based on committee decision, such as practitioner quality chart reviews to determine individual practice patterns in order to evaluate performance against the standard of care and peer group performance.
  • Develops and maintains a formalized process for sharing of quality of care practitioner information at an enterprise level working with legal, credentialing, medical staff affairs, provider network management, and the medical group.
  • Develops and maintains process for internal and external peer review in consultation with legal. This may require identifying external practitioners for specialty being reviewed, contacting practitioner for ability to act in this capacity, making financial arrangements for services, and handling all logistics to send and receive peer review opinions.
  • Manages the quality of care database for occurrence screening, quality of care reporting, and to monitor and evaluate issues as a network. Uses the data to drive decisions and plan/implement performance improvement strategies.
  • Develops training materials to address individual and network-wide improvement opportunities and collaborates with Provider Services staff to develop and implement the approach that will be most effective in influencing practice.
  • Advises leadership in the identification of system processes that could be improved to maximize patient safety, optimize positive patient outcomes, and minimize financial loss. Participates on process improvement teams as appropriate.
  • Performs other functions as required, i.e. cross-training with Critical Incidents, clinical quality projects.


Education: Bachelors degree required, BSN preferred.

Credentials: Registered Nurse - State of New Mexico or Compact State Nursing License.


Three years experience in clinical nursing field required.

Three years quality improvement experience preferred.

Three years case management or care coordination experience preferred.

Excellent written, oral, and facilitation skills required.

Skills in Word, Excel, Outlook, and Power Point necessary.

Ability to work with highly sensitive and confidential information.


Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.


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