Health Plan RN Registered Nurse Quality of Care

Primary City/State:

Department Name:

Work Shift:

Job Category:

At Banner Health, we believe that "leadership matters" and is a key component to providing excellent patient care. Join a nationally recognized leader that values excellence, and begin making a difference in people's lives.

As a Quality of Care Behavioral Health RN, you will support our Banner Health Plans. It is essential for this role to have behavioral health experience and previous experience working in a quality management department. Banner Health has been awarded the contract, AHCCCS Complete Care- a plan that will be focused on the integration of physical health and behavioral health. We are known nationally as an innovative leader in new health care models, where insurance plans and physicians come together to work collaboratively to make things easier for the member. The division serves over 500,000 members in our community. Join a team that strives to provide member safety, supportive environment that fosters healing and facilitates a return to the highest possible level of independence. CPHQ preferred, but not required.

There is periodic travel to facilities in Arizona for health and safety checks (could be outside normal business hours); mileage reimbursement included. This position is eligible to work remote 2-3 days per week!

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

Banner University Health Plans (BUHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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

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