Registered Nurse

Iannarino Fullen Group; Phoenix (AZ); Hybrid; USD 70,000 - 100,000; Full time

Job summary

The Division of Developmental Disabilities – Quality Management Unit seeks a qualified Quality Management Investigative Nurse to conduct comprehensive investigations of member-related and systemic quality-of-care concerns. The role emphasizes analytical review of medical records, evidence gathering, and reporting with corrective actions when needed.

You will work primarily remote with a Monday–Friday schedule, 40 hours per week, and the first day on-site for equipment and training.

Qualifications

• Active, unrestricted license to practice as an LPN or RN in Arizona.
• Experience reviewing and synthesizing medical records and documents.
• Ability to develop evidence-based conclusions and defensible reports.

Responsibilities

• Conduct timely, thorough investigations of quality-of-care concerns.
• Review medical records, clinical documentation, and information from multiple sources.
• Prepare detailed investigative reports and recommendations for corrective actions.

Skills

Critical Thinking

Clinical Judgment

Investigative Skills

Analytical Skills

Report Writing

Microsoft Office

Education

Arizona LPN or RN license

Tools

Microsoft Office

Databases

Email

Electronic documentation systems

Job description

Division of Developmental Disabilities – Quality Management Unit

Work Schedule & Location

• Hours: Monday–Friday, 8:00 AM–5:00 PM
• Schedule: 40 hours per week; no weekends.
• Work Arrangement: Primarily remote.
• First-Day Requirement: The first day must be completed in person to obtain required equipment and complete mandatory security training before receiving access to applicable systems.

Position Overview

The Quality of Care Investigative Nurse is responsible for conducting comprehensive investigations of member-related and systemic quality-of-care concerns.

This role requires more than traditional clinical nursing experience. The ideal candidate will possess strong investigative, analytical, and critical-thinking skills, with the ability to review complex medical records, gather information from multiple sources, identify inconsistencies and patterns, evaluate evidence, and prepare detailed, objective, and defensible investigative reports.

The nurse will help ensure member health, safety, and well-being through thorough investigations, appropriate recommendations, and implementation of corrective actions when necessary.

Key Responsibilities

• Conduct timely, thorough, and member-centered investigations of quality-of-care concerns.
• Participate in investigations involving individual member concerns and systemic quality-of-care issues.
• Review and analyze medical records, clinical documentation, and information obtained from multiple sources.
• Identify inconsistencies, trends, patterns, and potential gaps in care or compliance.
• Request, collect, organize, and evaluate appropriate documentation to support investigative findings.
• Maintain comprehensive and accurate case documentation to support allegation reviews and substantiation determinations.
• Prepare detailed, professional investigative reports, technical documentation, and correspondence.
• Evaluate findings and determine appropriate remediation or vendor-specific Corrective Action Plans (CAPs).
• Monitor and support corrective actions to address identified quality-of-care concerns.
• Ensure investigative documentation and supporting evidence are uploaded into the Quality Management System (QMS) Portal.
• Make appropriate referrals to regulatory and oversight agencies when necessary.
• Participate in Care Concerns, Care Needed Today, and other assigned member-related matters.
• Recognize and elevate complex cases, significant findings, and emerging trends to the Quality of Care Supervisor.
• Apply established investigative standards and processes consistently throughout case reviews.

Critical Thinking & Clinical Judgment

• Ability to critically evaluate complex clinical situations and determine appropriate conclusions.
• Strong clinical judgment and decision-making abilities.
• Ability to recognize inconsistencies, identify patterns, and connect information across multiple sources.
• Ability to assess the quality of care and evaluate clinical documentation against applicable standards.

Investigative & Analytical Skills

• Experience reviewing and synthesizing extensive medical records and supporting documentation.
• Ability to conduct research, evaluate evidence, and develop evidence-based conclusions.
• Strong problem-solving skills and the ability to identify potential quality-of-care concerns.
• Ability to investigate individual cases as well as identify broader systemic issues.

Professional Report Writing

• Ability to prepare clear, comprehensive, objective, and defensible investigative reports.
• Strong technical writing, documentation, and professional correspondence skills.
• Ability to clearly communicate investigative findings, supporting evidence, and recommendations.
• Proficiency with Microsoft Office applications, databases, email, and electronic documentation systems.
• Ability to navigate electronic referral, verification, and research resources.
• Strong organizational, planning, prioritization, and time-management skills.
• Oral and written communication.
• Medical chart review.
• Nursing process, including assessment, monitoring, and evaluation.
• Development of effective corrective action plans.
• Regulatory and clinical standards research.
• Ability to work independently and manage multiple investigations.

Required Education & Licensure

• Active, unrestricted license to practice as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Arizona.