Job Description Job Description
A-Line Staffing is now hiring a Quality of Care Investigative Nurse - LPN. Full Time.
- Schedule: Monday-Friday, 8:00 AM-5:00 PM
- Pay Rate: $32.48 an hour paid weekly
- Benefits - active after 90 days
- Work Arrangement: The first day will be conducted in person in Phoenix to receive necessary equipment and complete required security training for system access. Remaining training will be completed remotely.
Key Responsibilities
- Conduct member-centric and systemic quality-of-care investigations in accordance with established requirements and standardized processes.
- Review medical records, clinical documentation, and other relevant information to evaluate quality-of-care concerns.
- Request and organize appropriate documentation to support investigations and maintain comprehensive case records.
- Analyze allegations, evidence, and findings to determine appropriate levels of substantiation.
- Develop and implement vendor-specific corrective action plans when appropriate.
- Issue remediation or corrective action based on investigation findings.
- Make appropriate referrals to regulatory and oversight agencies as needed.
- Participate in Care Concerns, Care Needed Today, and other member issues as assigned.
- Upload and maintain required investigative documentation within the AHCCCS QMS Portal.
- Identify and appropriately elevate cases, trends, and systemic concerns to the Quality of Care supervisor.
- Maintain accurate, timely, and professional investigative documentation, reports, and correspondence.
- Apply nursing knowledge, clinical judgment, and critical-thinking skills throughout the investigative process.
Required Qualifications
- Active LPN license in the State of Arizona.
- 6 months to a year of risk management, quality assurance nurse or auditing experience
INDKS
