Remote LPN - Quality of Care {176903}

Job Description

Job Description

A-Line Staffing is now hiring a Quality of Care Investigative Nurse – LPN. Full Time.

• Schedule: Monday–Friday, 8:00 AM–5:00 PM
• Pay Rate : $32.48 an hour paid weekly
• Benefits – active after 90 days
• Work Arrangement: The first day will be conducted in person in Phoenix to receive necessary equipment and complete required security training for system access. Remaining training will be completed remotely.

Key Responsibilities

• Conduct member-centric and systemic quality-of-care investigations in accordance with established requirements and standardized processes.
• Review medical records, clinical documentation, and other relevant information to evaluate quality-of-care concerns.
• Request and organize appropriate documentation to support investigations and maintain comprehensive case records.
• Analyze allegations, evidence, and findings to determine appropriate levels of substantiation.
• Develop and implement vendor-specific corrective action plans when appropriate.
• Issue remediation or corrective action based on investigation findings.
• Make appropriate referrals to regulatory and oversight agencies as needed.
• Participate in Care Concerns, Care Needed Today, and other member issues as assigned.
• Upload and maintain required investigative documentation within the AHCCCS QMS Portal.
• Identify and appropriately elevate cases, trends, and systemic concerns to the Quality of Care supervisor.
• Maintain accurate, timely, and professional investigative documentation, reports, and correspondence.
• Apply nursing knowledge, clinical judgment, and critical-thinking skills throughout the investigative process.

Required Qualifications

• Active LPN license in the State of Arizona.
• 6 months to a year of risk management, quality assurance nurse or auditing experience

INDKS