RN Quality of Care Specialist (Remote)

Banner Health; Arizona; Hybrid; USD 45,000 - 76,000; Full time

Job summary

Banner Health is seeking an RN to support Banner University Health Plan Quality of Care activities. The role reviews medical records for quality of care, investigates concerns via AHCCCS, triages referrals, and collaborates with providers and internal teams.

Occasional onsite visits in the Phoenix metro area required, with initial on-site orientation and remote training thereafter. Phoenix-based candidates only.

Qualifications

• Two years of clinical experience in an acute care or outpatient setting.
• Must possess a current, valid RN license in state of practice.
• Knowledge of National Medicare and State AHCCCS regulations.
• Excellent written and verbal communication skills; strong analytical and data management abilities.
• Ability to work independently and coordinate care while adhering to quality standards.

Responsibilities

• Investigates referred Quality of Care concerns, including medical record documentation review and tracking cases.
• Prepares Quality of Care cases and presents them to Medical Director for review.
• Assists in training program development and implementation for BUHP Quality of Care.
• Communicates monitoring results to QOC Medical Director, QM Director and QOC Supervisor.
• Identifies potential risk management and compliance issues during quality review.
• Coordinates care to ensure member needs are met while maintaining financial responsibility.

Skills

clinical experience

strong communication

data management

problem solving

Education

Registered Nurse (RN) license

Job description

Banner Health is seeking an RN to support Banner University Health Plan Quality of Care activities. The role reviews medical records for quality of care, investigates concerns via AHCCCS, triages referrals, and collaborates with providers and internal teams.

Occasional onsite visits in the Phoenix metro area required, with initial on-site orientation and remote training thereafter. Phoenix-based candidates only.