RN Quality of Care

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Review medical records for quality of care cases.

• Utilize the AHCCCS portal to investigate concerns and ensure compliance.

• Support the safety of members.

• Triage new referrals assigned weekly.

• Collaborate with providers and internal teams.

• Occasionally travel to conduct onsite health and safety visits within the Phoenix metro area.

• Investigate referred Quality of Care concerns.

• Obtain responses from providers and prepare acknowledgment and closure correspondence.

• Track cases in a database.

• Prepare Quality of Care cases and present findings to the Medical Director.

• Assist with the development and implementation of the training program for Quality of Care at Banner University Health Plan.

• Communicate monitoring and evaluation results to the QOC Medical Director, QM Director, and QOC Supervisor.

• Identify potential risk management, FWA, and compliance issues for referral to the appropriate staff.

• Coordinate care to ensure member needs are met while upholding quality standards and financial responsibility.

⛳️ Requirements

• A minimum of two years of clinical experience in an acute care or outpatient setting for Physical Health positions.

• At least two years of behavioral health experience along with strong healthcare knowledge for Behavioral Health positions.

• Current and valid RN license in the state of practice.

• Familiarity with National Medicare and State AHCCCS regulations.

• Excellent written and verbal communication skills.

• Strong analytical, problem-solving, concurrent and retrospective data management, and computer skills.

• Ability to recognize variances from protocol.

• Capacity to independently identify, develop, monitor, evaluate, report, and conduct ongoing, objective, cyclic, and systematic QI indicator data.

• Ability to build strong working relationships with support staff, providers, administrative staff, and both internal and external customers.

• Experience in a quality management role is preferred.

• CPHQ certification is preferred.

• Additional related education and/or experience is preferred.

🏝️ Benefits

• Remote opportunity following the initial three days of onsite orientation and approximately eight weeks of Teams training.

• Flexible start times.

• Monday to Friday 8-hour day shifts with no evening or overnight work.

• Comprehensive total rewards package.