[Hiring] HP RN Quality of Care @Banner Health

Role Description

As a HP RN Quality of Care, you will support our Banner Health Plans by:

• Reviewing medical records for quality of care cases.
• Using the AHCCCS portal to investigate concerns, ensure compliance, and support member safety.
• Triage new referrals assigned each week.
• Collaborating with providers and internal teams.
• Occasionally traveling to conduct onsite health and safety visits in the Phoenix metro area.

This position is on-site during the initial three days of orientation, followed by training over Teams (typically the first 8 weeks). Your work shifts will be Monday-Friday 8-hour shifts with flexible start times; there are no evenings or overnights. This is a remote opportunity. CANDIDATES MUST LIVE IN THE PHOENIX METRO AREA.

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.
• 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.
• 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.

Qualifications

• Two years of clinical experience in an acute care or outpatient setting (Physical Health position).
• At least two years of behavioral health experience and strong healthcare knowledge (Behavioral Health position).
• 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.
• Ability to identify variances from protocol and work independently to identify, develop, monitor, evaluate, report and perform ongoing, objective, cyclic, and systematic QI indicator data.
• Ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff and all other internal and external customers.

Requirements

• Experience working in a quality management role in an outpatient or inpatient setting is preferred.
• A CPHQ is preferred.
• Additional related education and/or experience preferred.

Benefits

• Estimated Pay Range: $33.77 - $56.28 / hour.
• Banner Health is committed to pay equity and transparency.
• This range is based on possible base salaries and does not include the value of our total rewards package.
• Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location.

EEO Statement

EEO/Disabled/Veterans. Our organization supports a drug-free work environment.