Quality of Care RN New

Business Objective:

Our client is seeking an experienced and motivated Quality of Care Registered Nurse (RN) to support clinical quality initiatives across the system and assist with the volume increase of caseload (they see this as a permanent influx and not a surge). The primary purpose of this position coordinate the investigation of quality of care concerns for Banner Health Plans members who have been referred to the Quality Management Department for review and resolution.

Hard Requirements:

• Active RN license in the state of Arizona (compact license also acceptable)
• Two years of clinical experience in an acute care or outpatient setting; Preferably 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.
• Ability to analyze charts- to identify concerns, determine if they occurred, and understand member outcomes
• Experience with incident reports/sentinel events- experience with investigating these types of events, either from a hospital or similar setting.
• Experience working with clinicians inside and outside their scope
• Demonstrated knowledge of quality management principles, healthcare regulations, and evidence-based practice

Responsibilities:

1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider/facility 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 Health Plan Quality of Care training program.
4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, MM and Clinical Quality of Care (CQOC) Director, Senior Manager, and CQOC Supervisor.
5. Identifies potential Risk Management, FWA, and Compliance issues during process of quality investigation and refers to appropriate staff/departments.
6. This position makes decisions which facilitate smooth coordination of care to ensure member’s care needs are met while maintaining quality standards in a financially responsible manner. Clinical Reviewers perform independently.
7. On occasion, there is a need to participate in on-site Health and Safety facility visits, which can occur after hours or on weekends.