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RN - Registered Nurse - Quality Management - ALTCS
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Tucson, AZ Tucson, Arizona |
About this job
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 RNs to join the Quality team. These positions will support our ALTCS line of business. The nurses in this area are required to complete Quality of Care and mortality reviews for the state. They also complete investigations and interview providers as needed. There will be travel throughout Arizona and being on call when necessary.
Preferred qualifications include a BSN and ALTCS experience.
This position may be able to work from home 2-3 days a week
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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.
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 change the way care is provided. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
* --
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.
Banner University of Arizona Health Plans is currently seeking RNs to join the Quality team. These positions will support our ALTCS line of business. The nurses in this area are required to complete Quality of Care and mortality reviews for the state. They also complete investigations and interview providers as needed. There will be travel throughout Arizona and being on call when necessary.
Preferred qualifications include a BSN and ALTCS experience.
This position may be able to work from home 2-3 days a week
* --
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.
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 change the way care is provided. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
* --
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.