Quality Management Nurse

VHS PHOENIX HEALTH PLAN, INC.
JOB DESCRIPTIONJOB TITLE:Quality Management Nurse
DEPARTMENT:Quality ManagementPRIMARY OBJECTIVES OF POSITION:
This position, under the direction of the Director of Quality Management, will be responsible to assist in developing, implementing, and monitoring quality projects and programs as needed to ensure that all contract requirements and PHP business initiatives are completed successfully and timely. This position will assist in the clinical quality of care review process, the medical record audit process, and analysis of data for presentation to appropriate health plan committees. This position will work closely with the Provider Services department to ensure provider compliance with requirements and best practices. This position works to maintain a highly functioning quality organization, characterized by teamwork, cooperation, efficiency, innovation and excellence.RESPONSIBILITIES•Assists in developing clinical medical record audit tools and processes•Performs medical record audits to determine provider compliance with established standards•Works with Provider Services staff to ensure provider understanding and compliance with required elements of medical record documentation•Communicates audit results to providers along with education about best practices, and maintains that information in the appropriate provider files•Aggregates and analyzes medical record audit results on a annual basis for presentation to the Clinical and Service Quality Improvement Committee (CSQIC)•Assists in review of clinical quality of care issues through review, investigation, provider correspondence and tracking, and initiation of provider interventions•Aggregates and analyzes quality of care issues for presentation to the Clinical and Service Quality Improvement Committee (CSQIC) and for inclusion in the annual Quality Evaluation•Assists with the development of the QM/UM plan and evaluation and monitoring of work plan activities•Assists with and/or coordinates projects as directed by the Director of Quality Management•Responsible for working toward achieving full compliance in assigned areas on the annual AHCCCS operational review and to complete all assigned work plan tasksExcellent Benefit PackageWe are located on the corner of 16th Street and Northern.Email resumes to [Click here for email], Wendy Coyle, HR Director.
REQUIREMENTS
KNOWLEDGE, SKILLS AND ABILITIES•Active Arizona RN unrestricted license or Master’s degree of in health services or public health•Minimum 5 years experience as an RN or in the public health field•Minimum 3 years experience in Quality Management/Case Management•Excellent interpersonal skills (both verbal and written)•Excellent leadership and problem solving skills for directing a production-oriented work team•General background knowledge of managed care delivery system and previous experience in a managed care organization preferred•Computer experience or aptitude to learn computer skills as needed for the position