HP RN Quality of Care

Core Functions

• 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.
• Aids 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 the process of quality review for referral to the Risk Management and other appropriate staff.

Minimum Qualifications

• Physical Health position: Two years of clinical experience in an acute care or outpatient setting.
• Behavioral Health position: At least two years of behavioral health experience and strong healthcare knowledge.
• Must possess a current, valid RN license in state of practice.
• Knowledge of National Medicare and State AHCCCS regulations is required.
• Excellent written and verbal communication skills, strong analytical, problem-solving, concurrent and retrospective data management, and computer skills are necessary.
• The ability to identify variances from protocol and the ability to work independently to identify, develop, monitor, evaluate, report, and perform ongoing, objective, cyclic, and systematic QI indicator data.
• The ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff, and all other internal and external customers.

Preferred Qualifications

• Experience working in a quality management role in an outpatient or inpatient setting is preferred.
• A CPHQ is preferred.