**Department Name:** Quality **Work Shift:** Day **Job Category:** Risk, Quality and Safety **Estimated Pay Range:** $33.11 - $55.18 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare, Medicaid, and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. Clinical Quality of Care works to ensure BPN members receive the appropriate, quality medical and psychological care they deserve. As a Health Plan Registered Nurse RN Behavioral Health Quality of Care, you will call upon your behavioral health nursing background, chart review skills, and knowledge of both national and Arizona behavioral health statutes to make decisions for the coordination of patient care. You will use your triaging skills to determine whether a referral meets the qualifications to open for investigation and determine what next steps should be taken. Your role will be part of a cross functional team which includes LMSWs. You will coordinate and confer with other team members on a daily basis, present cases to the medical directors as needed, conduct occasional on-site visits to ensure our members are safe. Your investigations will have an impact on the care provided to BPN members. Your work location style will be remote hybrid. You will have a remote base of a home office and occasional facility visits. **This role does require Phoenix, Arizona Metro residency for compliance** . Your work week will **primarily be Monday-Friday, Arizona business hours** , with flexibility for appointments as needed. Our department follows the work/life balance mantra, as family and personal life is important. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position coordinates the investigation of quality of care concerns for Banner University Health Plan members that have been referred to the Quality Management Department for review and resolution. CORE FUNCTIONS 1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database. 2. Prepares Quality of Care cases and presents cases to Medical Director for review. 3. Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program. 4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor. 5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff. 6. This position makes decisions that facilitate smooth coordination of care to ensure member’s care needs are met while maintaining quality standards in a financially responsible manner. Performs independently. MINIMUM QUALIFICATIONS Two years of clinical experience in an acute care or outpatient setting; at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required Must possess a current, valid RN license in state of practice. Knowledge of National Medicare and State AHCCCS regulations is required. Excellent written and verbal communication skills, strong analytical, problem solving, concurrent and retrospective data management and computer skills are necessary. The ability to identify variances from protocol and the ability to work independently to identify, develop, monitor, evaluate, report and perform ongoing, objective, cyclic, and systematic QI indicator data, and the ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff and all other internal and external customers. PREFERRED QUALIFICATIONS A CPHQ is preferred Additional related education and/or experience preferred. **EEO Statement:** EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo) Our organization supports a drug-free work environment. **Privacy Policy:** Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy) EOE/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability