City
Phoenix
State
AZ
Position Id
2318

Quality RN
Phoenix, Arizona

Job Summary:

This nursing position is responsible for the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. Responsibilities include leading, evaluating, investigating, monitoring, providing oversight, and coordination for behavioral, dental, and physical health services for children in foster care throughout the state of Arizona. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of State and Federal policies, evidence-based criteria, and guidelines as well as recognized community standards, as appropriate. This role requires research, data analysis, data interpretation, and the utilization of quality tools for contributions to continuous improvement. This role contributes to the development and maintaining of documentation needed for compliance and accreditation(s).


Major Responsibilities/Essential Functions:

  • Contributes to individual and systemic quality of care for the DCS CHP Quality Department. Performs medical necessity reviews, investigations, and follow-ups of quality-of-care concerns, complaints, and grievances. Conducts on-site quality management required visits and/or reviews as needed. Reports, tracks and trends, resolves various measures for quality improvement department wide.
  • Reviews, consult, and advises on Root Cause Analysis (RCA) and Failure, Mode, Effects and Analysis (FMEA), data gathering and reporting on cases based on set criteria to troubleshoot difficult, complex cases, new technology requests, DCS Management system efforts and other quality strategies for quality improvement with the ability to communicate results.
  • Communicates with clinical/non-clinical staff, healthcare providers and other healthcare professionals to gather, provide education, report and contribute to continuous improvement as the Quality Department's subject matter expert in areas of Behavioral Healthcare and Physical Healthcare. Manages and responds appropriately to requests in the Quality Inbox. Presents on materials that are quality specific in areas of quality as needed.
  • Interprets and applies statutes, regulations, and AHCCCS policy and rules; Completes audits, performance review reporting, AHCCCS requests, HEDIS reports, accreditation reports and other reports required from the Quality Department or as support to other areas within the DCS CHP.
  • Participates and/or available telephonically for periods beyond regular work hours on a rotational basis; handle incoming telephonic inquiries from pharmacies, members, providers, caregivers and DCS staff during off hours.
  • Participates in compliance and accreditation activities, as appropriate. Participates in committees as assigned.

Licenses/Certifications:

  • Current, active AZ RN license; in good standing with AZ Nursing Board.
  • Requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment.
  • The ability to secure and maintain an Arizona Fingerprint Clearance Card; and the ability to secure and maintain clearance from the CPS Central Registry.

To learn more, please contact Nick at nick@apnusa.com or call 602-788-5890.