Remote RN: Quality of Care & Compliance Lead

Banner Health; Arizona; Remote; USD 47,000 - 78,000; Full time

Job summary

Banner Health is seeking an HP RN Quality of Care to support Banner University Health Plan. You will review medical records, investigate quality-of-care concerns, and collaborate with providers and internal teams.

Travel to Phoenix metro area for on-site health and safety visits may be required, with initial orientation on-site and training via Teams. The role emphasizes triaging referrals, ensuring patient safety, and maintaining compliance with AHCCCS and Medicare regulations.

Qualifications

• Current, valid RN license in state of practice.
• Minimum two years clinical experience in acute care or outpatient setting (two years for Behavioral Health).
• Excellent written and verbal communication skills with strong analytical, problem solving, data management and computer skills.
• Knowledge of National Medicare and State AHCCCS regulations.

Responsibilities

• Investigate referred Quality of Care concerns, including medical record review and respondent coordination.
• Prepare Quality of Care cases and present to Medical Director for review.
• Assist in development and implementation of BUHP Quality of Care training program.
• Communicate monitoring results to QM leadership and QOC Supervisor.
• Identify potential risk management and compliance issues during quality review.
• Make decisions to coordinate care and maintain quality standards in a financially responsible manner.

Skills

RN license

Clinical experience

Analytical skills

Communication skills

Data management

Job description

Banner Health is seeking an HP RN Quality of Care to support Banner University Health Plan. You will review medical records, investigate quality-of-care concerns, and collaborate with providers and internal teams.

Travel to Phoenix metro area for on-site health and safety visits may be required, with initial orientation on-site and training via Teams. The role emphasizes triaging referrals, ensuring patient safety, and maintaining compliance with AHCCCS and Medicare regulations.