Quality of Care Investigative Nurse

VIVA; Phoenix (AZ); Hybrid; USD 70,000 - 90,000; Full time

Job summary

VIVA USA Inc in Phoenix, AZ seeks a Quality of care Investigative Nurse to conduct complex quality-of-care investigations and write defensible, evidence-based reports. You will review records from multiple sources, identify patterns, and drive corrective actions to improve member safety and care quality.

The role requires an active AZ RN or LPN license, strong clinical judgment, and experience in risk management or quality assurance.

Qualifications

• Active license to practice as an LPN or RN in AZ.
• Experience in risk management, quality assurance, or auditing is preferred.
• Bachelor-level or higher degree with healthcare quality emphasis preferred.

Responsibilities

• Conduct complex quality-of-care investigations and writes detailed, defensible reports.
• Maintain comprehensive case records and documentation across sources.
• Develop corrective action plans and coordinate with vendors/regulators as needed.
• Elevate cases to QOC supervisor and drive remediation.

Skills

Critical Thinking

Clinical Judgment

Professional report writing

Oral & written communication

Organization & time management

Nursing Process

Decision making

Data analysis

Education

Active AZ RN or LPN license

BSN preferred

MS/Doctorate preferred

Tools

Microsoft Office

Databases

Email systems

QMS Portal

Job description

Hybrid. Remote Work: The first day would need to be in person to obtain equipment and complete necessarysecurity training to be able to access systems.

Quality of care Investigative Nurse

This position reports to the Client – Quality Management Unit and conducts quality-of-care investigations pursuant to the contract between the client and the Health Care Cost Containment System (HCCCS).

This position participates in investigations of member-centric and systemic quality-of-care concerns to ensure member health and well-being.

Conducts timely, thorough, member centric, and systemic investigations of all division member quality-of-care issues and implements vendor-specific corrective action plans, utilizing a standardized process. Makes appropriate referrals to oversight and regulatory agencies.

Participates in Care Concerns, Care Needed today, and member issues as assigned.

Maintains all necessary documentation to support case work.

Request appropriate documentation for quality-of-care investigations and ensure the maintenance of comprehensive case records to support allegation review and substantiation levels.

As a result of the QOC Investigation, issue remediation or a Corrective Action Plan to the vendor, and ensure all applicable investigative information and documents are uploaded within the client QMS Portal.

Appropriately elevates cases and/or trend concerns to the QOC supervisor.

Overview

We need nurses who can investigate complex cases, analyze information from multiple sources, identify inconsistencies or patters, and write detailed, defensible reports.

Skills

• Critical Thinking
• Clinical Judgment
• Professional Report writing

Technological skills, including the use of databases, Microsoft Office products, email, and electronic referral and verification sources.

• Producing professional technical reports and letters.
• Research and analysis.
• Oral and written communication skills.
• Personal planning, organization, and time management.
• Medical chart review.
• Nursing Process, including assessment, monitoring, and evaluation.
• Decision-making skills.
• Critically analyze problems and develop effective plans for corrective action.

Required Education

Active license to practice as a LPN or RN in AZ.

Preferred Qualifications

For the extensive experience we are seeking the nurses will typically have a Bachelors Degree (BSN), Masters degree or doctoral -level.

Experience preparing formal investigative reports, conducting clinical research, performing quality of -care reviews or evaluating compliance with clinical standards.

Background in healthcare quality assurance risk management utilization review, clinical auditing, regulatory compliance or patient safety.

Experience analyzing complex cases that require synthesis of extensive records and evidence-based conclusions.

Required Skills

6 months to a year of risk management, quality assurance nurse or auditing experience

Active license as a Registered Nurse (RN) in AZ

Notes

Hybrid

Schedule

Remote Work: The first day would need to be in person to obtain equipment and complete necessary security training to be able to access systems.

8am -5pm no weekends 40 hours per week.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status