The Peer Review Nurse advances patient safety, quality of care, and professional accountability by coordinating peer review, supporting Ongoing Professional Practice Evaluation (OPPE/FPPE), conducting clinical audits, and participating in Root Cause Analyses (RCAs). This role serves as a key liaison among providers, compliance, nursing, quality, and leadership, ensuring that findings from reviews and audits translate into sustainable improvements in clinical practice, patient outcomes, and systems of care.

*** This position is located in Austin, Texas, To be considered for this role, you must reside in the greater Austin area. ***

Essential Functions:

Peer Review:

• Coordinate and facilitate peer review in accordance with bylaws, policies, and accreditation standards.
• Facilitate preparation of peer review committee meetings and associate materials with clinical leadership, legal and compliance.
• Screen, review, and prepare cases for committee review.
• Partner with physician and APP reviewers to ensure objective, equitable, and consistent evaluation of clinical care.
• Track, document, and report peer review outcomes, ensuring timely feedback, education, and follow-up.
• Safeguard the confidentiality of peer review activities and records.

Clinical Auditing:

• Conduct routine and targeted clinical audits to evaluate compliance with standards, guidelines, and regulations.
• Analyze data on outcomes, adverse events, complications, and provider performance.
• Identify trends, risks, and opportunities for system or process improvement.
• Develop and present clear audit reports to Quality, Risk Management, and leadership committees.
• Ongoing Professional Practice Evaluation (OPPE/FPPE)
• Collect, analyze, and report provider performance data to support credentialing and privileging decisions.
• Collaborate with service chiefs, committees, and medical staff services to evaluate practitioner competence and professionalism.
• Track and monitor key indicators such as complications, readmissions, complaints, and regulatory triggers.
• Assist with dashboards, performance reports, and improvement strategies based on OPPE/FPPE findings.

Root Cause Analyses (RCAs) & Quality Improvement:

• Participate in RCAs for sentinel events, near misses, and high-risk occurrences.
• Collaborate with interdisciplinary teams to identify contributing factors and system vulnerabilities.
• Support corrective action plan development, monitoring, and evaluation.
• Partner with providers, nurses, and leadership to design and implement QI projects informed by peer review, audits, and RCAs.
• Apply evidence-based practices and improvement methodologies (PDSA, Lean, Six Sigma) to drive measurable change.
• Provide education and coaching on QI methods to staff and providers.

Collaboration & Education:

• Act as a liaison across nursing, providers, quality, and leadership teams to align review and evaluation processes.
• Prepare and deliver reports, dashboards, and presentations on peer review, OPPE/FPPE, audits, and improvement initiatives.
• Promote a culture of accountability, professionalism, and high reliability.

QUALIFICATIONS:

Education:

Bachelor's Degree (higher degree accepted) In Nursing - (BSN) - Required

Work Experience:

3-5 years of clinical nursing experience. - Required

Experience in quality management, peer review, provider performance evaluation, or patient safety - Preferred

Licenses and Certifications:

Unrestricted Registered Nurse (RN) License in the State of Texas Upon Hire - Required