Analysis Skills, Communication Skills, Corrective Action, Cost Control, Document Management, Healthcare, Healthcare Quality, Microsoft Office, Microsoft Product Family, Nursing, Patient Charts, Presentation/Verbal Skills, Problem Solving Skills, Quality Management, Quality of Care, Registered Nurse (RN), Regulations, Support Documentation, Time Management, Vendor/Supplier Planning, Writing Skills
Job Overview
Join our dedicated team in Phoenix, AZ, and play a critical role in ensuring quality healthcare services. This position is part of the Quality Management Unit, where you will conduct comprehensive quality-of-care investigations in collaboration with the Arizona Health Care Cost Containment System (AHCCCS). Your work will focus on both member-centric and systemic quality concerns, contributing to the health and well-being of our community.
Key Responsibilities
- Conduct timely and thorough investigations into quality-of-care issues, focusing on both individual member and systemic concerns.
- Implement vendor-specific corrective action plans using standardized processes.
- Make appropriate referrals to oversight and regulatory agencies as needed.
- Participate in various member-related issues as assigned, maintaining comprehensive documentation to support case work.
- Request and manage appropriate documentation for investigations, ensuring comprehensive case records.
- Issue remediation or Corrective Action Plans to vendors as a result of investigations.
- Ensure all relevant investigative information and documents are uploaded to the AHCCCS QMS Portal.
- Elevate cases and trend concerns to the supervisor when necessary.
Skills Required
- Critical thinking and decision-making skills.
- Proficiency in technological tools, including databases, Microsoft Office products, email, and electronic referral and verification sources.
- Ability to produce professional technical reports and letters.
- Strong research and analysis capabilities.
- Excellent oral and written communication skills.
- Strong personal planning, organization, and time management skills.
- Experience in medical chart review and the Nursing Process, including assessment, monitoring, and evaluation.
- Ability to critically analyze problems and develop effective plans for corrective action.
Required Education
Candidates must possess and maintain an active license to practice as a Registered Nurse (RN).
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Talent Software Services, Inc.