HP RN Quality of Care NE

Position Summary

This position coordinates the investigation of quality of care concerns for Banner University Health Plan members that have been referred to the Quality Management Department for review and resolution.

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 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, and 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.