MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient‑centric, affordable, and high‑quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value‑based and other care models.
Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.
Position Summary
This position requires full understanding and active participation in fulfilling the mission of Orange Coast Medical Center. It is expected that the employee will demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion, and Synergy. The employee shall support MemorialCare Medical Centers’ strategic plan and participate in and advocate for performance improvement and patient safety activities.
The RN Coordinator, Quality Improvement, is responsible for managing and facilitating the medical staff's peer review process, as well as supporting patient safety and continuous quality improvement. This position works closely with the medical staff, the Executive Director of Quality, and the peer review committee to ensure compliance with organizational policies, medical staff bylaws, and regulatory standards. This includes coordinating case reviews, providing accurate summaries, maintaining confidentiality, and supporting quality improvement initiatives. The coordinator will be responsible for providing accurate clinical summaries, data trending, reports, and analysis. Assists in the development and implementation of strategies to improve medical staff performance metrics.
Essential Functions and Responsibilities of the Job
Work in conjunction with the medical staff leadership, Medical Staff Department, and Executive Director of Quality to coordinate and facilitate the medical staff peer review process.
Collaborate with physicians and other healthcare professionals at all levels to facilitate the medical staff's peer review process.
Review, summarize, and analyze medical records for case review summaries and data trending, reports, and analysis.
Attend medical staff peer review meetings and serve as a liaison between various committees to facilitate communication and referral of cases for further medical staff review.
In collaboration with the Medical Staff Department, coordinate follow‑up and action items from the peer review committee.
Facilitate, lead, and actively participate in medical staff improvement efforts across departments and service lines.
Participate in the review of medical staff performance metrics such as mortality and patient safety indicators.
Review, respond to, and oversee the insurance grievances related to the quality of care.
Maintain knowledge of evidence‑based, CMS, Joint Commission, and other regulatory agencies' standards/regulations pertaining to the medical staff peer review process and clinical metrics (e.g., eCQMs, AHRQ Patient Safety Indicators, Hospital Acquired Conditions, etc.).
Maintain knowledge of the hospital Medical Staff Bylaws, Rules and Regulations, and policies.
Maintain confidentiality of protected health information in compliance with HIPAA Privacy Rule.
Be at work and on time.
Follow company policies, procedures, and directives.
Interact in a positive and constructive manner.
Prioritize and multitask.
*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities.
Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more… Check out MemorialCare Benefits for more information about our Benefits and Rewards.
2 years’ experience in a clinical healthcare setting preferred.
Proficient in computer skills including Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) and Electronic Medical Record such as EPIC preferred.
Data Management proficiency and graphical display skills preferred.
Six Sigma, Lean, or other improvement certification preferred.
Expertise in quality, safety, and regulatory standards supported/required by external agencies such as The Joint Commission, Centers for Medicare and Medicaid Services (CMS), California Department of Public Health (CDPH), and Agency for Healthcare Research and Quality (AHRQ) preferred.
Education / Licensure / Certification:
Current California RN License required.
Bachelor’s Degree in Nursing or higher preferred.
Current certification/licensure of advanced, specialized study (such as CPHQ, CPPS, CPHFH, etc.) preferred.