Department Name: QualityWork Shift: DayJob Category: Risk, Quality and SafetyThe future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you! As a HP RN Quality of Care, you will support our Banner Health Plans. You will be reviewing medical records for quality of care cases, using the AHCCCS portal to investigate concerns, ensure compliance, and support member safety. You will also triage new referrals assigned each week, collaborate with providers and internal teams, and occasionally travel to conduct onsite health and safety visits in the Phoenix metro area to ensure members are receiving safe and appropriate care. 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. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.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 1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database. 2. Prepares Quality of Care cases and presents cases to Medical Director for review. 3. Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program. 4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor. 5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff. 6. 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. 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. Additional related education and/or experience preferred. Estimated Pay Range: $33.77 - $56.28 / hourBanner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.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, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy Originally posted on Himalayas