RN - Surgical Clinical Reviewer - FT - Days - MHS

Quality Improvement Data Analyst

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary: Collects and submits reliable data to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) through high-quality data compilation, documentation, and entry into the ACS NSQIP database of all eligible surgeries for the System.

Responsibilities: Reviews patient medical records and collects clinical data on variables, including pre-operative risk factors, intra-operative variables, and 30-day post-operative mortality and morbidity outcomes for patients undergoing minor/major surgical procedures in both inpatient and outpatient settings. Coordinates and facilitates the performance improvement process by interfacing with all applicable hospital departments and medical staff to ensure implementation of the performance improvement plan and to identify opportunities for clinical quality improvement. Participates in ongoing training, conferences (including the annual ACS NSQIP meeting) and calls to remain abreast of trends and requirements. Communicates with surgical patients via a 30-day follow-up letter or phone call and conducts periodic death searches in public records to obtain complete 30-day follow-up data. Validates and submits the data through a secure, Web-based system to ACS NSQIP, following data acquisition and transmission protocol to ensure completeness and accuracy. Conducts data audits, as instructed, and participates in regular audits conducted by ACS NSQIP to test data quality. Meets regularly with the Surgeon Champion and quality team to review results.

Competencies: ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CLINICAL POLICIES AND STANDARDS, CUSTOMER SERVICE, DEVELOPS RELATIONSHIPS, EFFECTIVE COMMUNICATION, PATIENT AND FAMILY CENTERED CARE, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK

Education and Certification Requirements: Bachelors: Nursing (Required) Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL)

Additional Job Information: Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be self motivated and able to work in a fast paced environment. Must be able to identify issues, conduct investigations and work collaboratively toward resolution. Required Work Experience: Two (2) years of clinical experience in the operating room, surgical intensive care unit, or cardiac surgery division of a hospital. Three (3) years of experience in Quality Improvement, Performance Improvement, or patient safety knowledge. Previous clinical chart review and abstraction experience required. Ability to complete all training modules and pass the certification examination. Other Information: Successful completion of an ACS NSQIP required training program within three (3) months of starting the position, and successful maintenance of certification as required by ACS.

Working Conditions and Physical Requirements:

• Bending and Stooping = 40%
• Climbing = 40%
• Keyboard Entry = 80%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 40%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 60%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 40%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 40%
• Taste Discrimination = 0%
• Depth Perception = 80%
• Distinguish Color = 80%
• Seeing - Far = 80%
• Seeing - Near = 80%
• Bio hazardous Waste = 60%
• Biological Hazards - Respiratory = 40%
• Biological Hazards - Skin or Ingestion = 40%
• Blood and/or Bodily Fluids = 40%
• Communicable Diseases and/or Pathogens = 40%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 40%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 60%
• Computer Monitor = 80%
• Domestic Animals = 40%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 40%
• Moving Mechanical Parts = 40%
• Needles/Sharp Objects = 40%
• Potential Electric Shock = 40%
• Potential for Physical Assault = 40%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 60%