Primary City/State: Arizona, Arizona Department Name: Quality Work Shift: Day Job Category: Risk, Quality and Safety Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. As a Health Plan Registered Nurse RN Quality of Care, you will call upon your quality management and nursing backgrounds to make decisions for the coordination of patient care. You will use your triaging skills to determine whether a referral meets the qualifications to open as a case to review and determine what next steps should be taken. Your role will be part of a cross functional team. You will coordinate and confer with other team members on a daily basis. Your work location style will be remote hybrid. You will have a remote base of a home office and intermittent facility visits. This role does require Tucson, Arizona Metro residency for compliance. Your work week will primarily be Monday-Friday, Arizona business hours. Call shifts will be discussed at the time of interview. If this role sounds like the one for you, Apply Today! Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. 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. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager. SUPERVISORY RESPONSIBILITIES DIRECTLY REPORTING None MATRIX OR INDIRECT REPORTING None TYPE OF SUPERVISORY RESPONSIBILITIES N/A Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner. PHYSICAL DEMANDS/ENVIRONMENT FACTORS OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager) Requires extensive sitting with periodic standing and walking. May be required to lift up to 20 pounds. Requires significant use of personal computer, phone and general office equipment. Needs adequate visual acuity, ability to grasp and handle objects. Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone. May require off-site travel. 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 EOE/Female/Minority/Disability/Veterans Our organization supports a drug-free work environment. Privacy Policy 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. We are proud to offer a comprehensive benefit package for all benefit-eligible positions. Please visit our Benefits Guide for more information. EEO/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. Privacy Policy