RN Quality of Care Investigator - Remote

Banner Health Corporate

Phoenix (AZ)

Hybrid

USD 45,000 - 76,000

Full time

4 days ago

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Job summary

Banner Health Corporate in Phoenix, AZ, seeks an RN Quality of Care to support Banner Health Plans by reviewing medical records for quality of care cases, investigating concerns via the AHCCCS portal, and ensuring compliance to safeguard member safety. Expect onsite orientation for three days, followed by training over Teams (8 weeks).

Typical schedule is Mon-Fri, 8-hour shifts; remote work is available with candidates residing in the Phoenix metro area.

Qualifications

Two years of clinical experience in an acute care or outpatient setting.
Current, valid RN license in state of practice.
Knowledge of National Medicare and State AHCCCS regulations.
Excellent written and verbal communication, strong analytical, problem solving, concurrent and retrospective data management and computer skills are necessary.
Ability to work independently to identify, develop, monitor, evaluate, report and perform QI indicator data.

Responsibilities

Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database.
Prepares Quality of Care cases and presents cases to Medical Director for review.
Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program.
Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor.
Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff.
This position makes decisions that facilitate smooth coordination of care to ensure member’s care needs are met while maintaining quality standards in a financially responsible manner. Performs independently.