Medical Staff Peer Review & Facility Enrollment Coordinator (FT)-Days

Position Summary:

Required RN training + Physician Peer Review experience 

In the role of Medical Staff Peer Review Coordinator and Facility Enrollment, this individual is responsible for coordinating and facilitating the medical and allied health staff peer review process to ensure quality, safety, and adherence to regulatory standards. Manages and coordinates the FPPE
(Focused Professional Practice Evaluation) and OPPE (Ongoing Professional Practice Evaluation) processes for both physician and advance practice professionals. This role involves organizing review activities, maintaining documentation, and supporting medical staff in continuous quality improvement efforts. This role facilitates the evaluation of practitioner competence, supports quality improvement initiatives, and maintains accurate documentation of professional practice assessments. In the role of
Facility Enrollment Specialist, this individual is responsible for managing the enrollment processes for the hospital’s and facilities within the organization. This role ensures that all entities are properly enrolled with insurance payers, government programs and other relevant entities, allowing Adena
Health to deliver services and receive reimbursement in a timely manner.
Minimum Qualifications
Required Educational Degree: Bachelor’s degree in healthcare administration, nursing, or related field
Major/Area of Concentration:
Preferred Education:
Required Certifications, Credentials and Licenses:
Preferred Certifications, Credentials and Licenses: Certified Peer Reviewer
Required Experience: 5 years in acute hospital setting
Preferred Experience: 2-3 years of Peer Review, Quality, Patient Safety and Facility Enrollment

Job Specific Knowledge, Skills & Abilities
Knowledge of medical staff processes, healthcare quality assurance, and regulatory standards. Strong organizational and communication skills. Ability to handle sensitive information with discretion.
Experience with healthcare documentation and data management systems. Experience in medical staff services, credentialing, or quality improvement. Knowledge of accreditation standards (e.g., The Joint
Commission), regulatory requirements, and healthcare quality metrics. Strong organizational, analytical, and communication skills. Attention to detail and ability to manage multiple priorities. Familiarity with healthcare data management systems and credentialing software. Excellent interpersonal and collaboration skills.
Ability to interpret and apply complex regulatory standards. Discretion and confidentiality in handling sensitive information.
Job Specific Essential Functions
• Peer Review: Coordinate the peer review process for medical staff, including scheduling, communication, and documentation. Collect, organize, and maintain peer review data, reports, and related records in compliance with hospital policies and regulatory requirements. Assist medical staff and reviewers with the review process, ensuring timely and thorough assessments.
Facilitate communication among medical staff, hospital administration, and review committees.
Prepare summaries, reports, and follow-up documentation related to peer review activities.
• FPPE/OPPE: Analyze and compare initial privilege requests to clinical benchmark criteria.
Oversee the implementation and ongoing administration of FPPE and OPPE programs.
Coordinate the collection, review, and documentation of practitioner performance data. Ensure timely completion of FPPE when practitioners are initially credentialed or after renewal. Monitor and facilitate OPPE activities for ongoing performance evaluation. Gather data from various sources such as peer reviews, patient outcomes, incident reports, and other quality metrics.
Analyze practitioner performance data to identify trends and areas for improvement. Prepare reports for medical staff leadership and hospital administration. Act as a liaison between medical staff, quality improvement, credentialing, and administrative departments. Educate physicians and providers on FPPE and OPPE processes and requirements. Facilitate communication regarding performance concerns and improvement plans. Ensure confidentiality and integrity of peer review information. Support compliance with accreditation standards and hospital policies regarding quality assurance and peer review. Assist in the development and implementation of policies and procedures related to peer review. Provide education and support to medical staff regarding peer review processes and expectations. Stay current with relevant regulations, standards, and best practices related to peer review and quality assurance.
Ensure all FPPE and OPPE activities align with Joint Commission standards, state regulations, and hospital policies. Maintain documentation to support accreditation and licensing audits.
• Facility Enrollment: Prepare and submit enrollment applications. Maintain accurate entity records. Track application statuses, and resolve any issues that may arise during the enrollment process. Ensure compliance with all relevant regulations and payer requirements. Assist with periodic audits of provider files, ongoing compliance requirements for delegated credentialing.
Administrator and Primary Contact for with payers and entities related to facility enrollment. i.e:
UHC portal, IHD-Medicaid, etc.
• Software: Administrator, SME, and Liaison with Symplr- DataVision and StatIT, Cactus- Peer
Review or other software identified for Peer Review, FPPE, or OPPE in the future.