Registered Nurse

This Registered Nurse position participates in investigations of member-centric and systemic quality-of-care concerns to ensure member health and well-being. Responsibilities Conducts timely, thorough, member centric, and systemic investigations of all division member quality-of-care issues and implements vendor-specific corrective action plans, utilizing a standardized process. Makes appropriate referrals to oversight and regulatory agencies. Participates in Care Concerns, Care Needed today, and member issues as assigned. Maintains all necessary documentation to support case work. Request appropriate documentation for quality-of-care investigations and ensure the maintenance of comprehensive case records to support allegation review and substantiation levels. As a result of the QOC Investigation, issue remediation or a Corrective Action Plan to the vendor, and ensure all applicable investigative information and documents are uploaded within the AHCCCS QMS Portal. Appropriately elevates cases and/or trend concerns to the QOC supervisor. Skills Critical thinking Technological skills, including the use of databases, Microsoft Office products, email, and electronic referral and verification sources. Producing professional technical reports and letters. Research and analysis. Oral and written communication skills. Personal planning, organization, and time management. Nursing Process, including assessment, monitoring, and evaluation. Critically analyze problems and develop effective plans for corrective action. Qualifications This position requires that the successful candidate possess and maintain an active license to practice as a Registered Nurse (RN) in the state of Arizona. CPR, ACLS, and BCLS Certification #J-18808-Ljbffr Iannarino Fullen Group