RN Quality of Care

🔥 8 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $33 - $56 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

📋 Description

• Review medical records for quality of care cases • Use the AHCCCS portal to investigate concerns and ensure compliance • Support member safety • Triage new referrals assigned each week • Collaborate with providers and internal teams • Occasionally travel to conduct onsite health and safety visits in the Phoenix metro area • Investigate referred Quality of Care concerns • Obtain provider responses and prepare acknowledgment and closure correspondence • Track cases in a database • Prepare Quality of Care cases and present them to the Medical Director • Assist with development and implementation of the Banner University Health Plan Quality of Care training program • Communicate monitoring and evaluation results to the QOC Medical Director, QM Director, and QOC Supervisor • Identify potential risk management, FWA, and Compliance issues for referral to appropriate staff • Coordinate care to ensure member needs are met while maintaining quality standards and financial responsibility

🎯 Requirements

• Two years of clinical experience in an acute care or outpatient setting for Physical Health positions • At least two years of behavioral health experience and strong healthcare knowledge for Behavioral Health positions • Current, valid RN license in state of practice • Knowledge of National Medicare and State AHCCCS regulations • Excellent written and verbal communication skills • Strong analytical, problem-solving, concurrent and retrospective data management, and computer skills • Ability to identify variances from protocol • Ability to independently identify, develop, monitor, evaluate, report, and perform ongoing, objective, cyclic, and systematic QI indicator data • Ability to establish good working relationships with support staff, providers, administrative staff, and internal and external customers • Experience working in a quality management role is preferred • CPHQ is preferred • Additional related education and/or experience is preferred

🏖️ Benefits

• Remote opportunity after initial three days of onsite orientation and approximately eight weeks of Teams training • Flexible start times • Monday-Friday 8-hour day shifts with no evenings or overnights • Total rewards package