Registered Nurse Quality Management - Health Plan

Job Number
210463
University Physicians Health Plans
Shift
Day
Department
University Physicians Health Plans - HP Statewide Quality
Position Type
FT: Full-Time
Street Address
2701 E. Elvira Rd.
City & State
US-AZ-Tucson
Posting Category
Nursing - Other

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If you are a New Graduate Nurse with less than 12 months of experience, please apply to our New Nurse Experience openings.


Banner University of Arizona Health Plans is currently seeking Registered Nurses to join the Quality team. The person who is selected can either work in the Phoenix or Tucson areas.

 

Join a team that strives to provide patients a safe, supportive environment that fosters healing and facilitates a return to the highest possible level of independence.  

 

These positions will support our ALTCS (Arizona Long Term Care System) line of business. Our nurses in this area are required to complete Quality of Care and mortality reviews for the state of Arizona.   RN's also complete investigations and interview providers as needed.  This role needs to follow heavy regulations by the state.

 

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

 

The preferred candidates will have the below qualifications:

  • BSN Preferred
  • Experience working with ALTCS
  • Extensive Case Management experience
  • Medical Records experience
  • Must be organized and mindful of strict timelines that need to be met

 

Why Should You Apply?

  • Competitive pay
  • Excellent growth and advancement opportunities
  • Work remote 3 days a week

 

Schedule - 7am-4pm or 8am-5pm

 

 

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About University Physicians Health Plans
The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care.

 

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Stage7-2013

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.

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Job Summary

The primary purpose of this position is to coordinate the investigation of quality of care concerns that have been referred to the Quality Management Department for review and resolution. The position is also responsible for assisting with education and training of health plan staff on the quality review process.

 

Essential 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. Assists in preparation of Quality of Care reporting

 

  • Prepares Quality of Care cases for Peer Review as necessary and presents cases to Medical Director for review.

 

  • Participates in the collection and maintenance of data appropriate to the Quality Improvement Program. Implements and tracks provider corrective actions as necessary.

 

  • Participates in the preparation of routine and special reports, including the quarterly report, to the UAHN Board of Directors.

 

  • Assist in the development and implementation of the Organization wide UAHP Quality of Care training program.

 

  • Communicates the results of the monitoring and evaluation process to relevant individuals, or departments.

 

  • Identifies potential risk management and peer review problems in process of quality review for referral to the Risk Management and other appropriate staff.

 

 

Minimum Qualifications

Two years of clinical experience in an acute care setting; at least one year of quality improvement experience 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 and State Ambulatory and Acute Care Quality Improvement requirements and guidelines for JCAHO, NCQA, HEDIS, HCFA, and AHCCCS 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 UAHP support staff, providers, administrative staff and all other internal and external customers. Ability to make professional presentations to department heads, section chiefs, and to outside professional organizations is needed.

Preferred Qualifications

A B.S.N. is preferred.

Additional related education and/or experience preferred.