Health Plan Registered Nurse Quality of Care Tucson Arizona

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.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.

Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE : The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties.

Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

SUPERVISORY RESPONSIBILITIES

DIRECTLY REPORTING

None

MATRIX OR INDIRECT REPORTING

None

TYPE OF SUPERVISORY RESPONSIBILITIES

N / A

Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.

PHYSICAL DEMANDS / ENVIRONMENT FACTORS

OE - Typical Office Environment : (Accountant, Administrative Assistant, Consultant, Program Manager)

Requires extensive sitting with periodic standing and walking.

May be required to lift up to 20 pounds.

Requires significant use of personal computer, phone and general office equipment.

Needs adequate visual acuity, ability to grasp and handle objects.

Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.

May require off-site travel.

MINIMUM QUALIFICATIONS

Two years of clinical experience in an acute care or outpatient setting; at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required

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

A CPHQ is preferred

Additional related education and / or experience preferred.

DATE APPROVED 06 / 16 / 2019

EOE / Female / Minority / Disability / Veterans

Our organization supports a drug-free work environment.

Privacy Policy