HP RN Quality of Care NE
Core
Investigate referred quality of care concerns by reviewing medical records, obtaining provider responses, and ensuring compliance with safety standards for Banner University Health Plan members.
Role type
Quality of Care Investigator (RN)
Builds
Quality assurance processes and member safety outcomes
Domain
Healthcare / Quality Management / Risk Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical record review, AHCCCS regulation knowledge, risk identification, data analysis, independent decision making, provider communication
Preferred skills
CPHQ certification, prior quality management experience
Technologies
AHCCCS portal, case management databases
Responsibilities
Review medical documentation for quality concerns, triage new referrals, collaborate with providers and internal teams, present cases to Medical Director, identify compliance issues, conduct onsite health and safety visits
Seniority
Mid-level, hands-on IC