Health Plans Quality Of Care Behavioral Health Registered Nurse RN

Banner Health Tucson , AZ 85704

Posted 2 months ago

At Banner Health, we believe that "leadership matters" and is a key component to providing excellent patient care. Join a nationally recognized leader that values excellence, and begin making a difference in people's lives.

Join a team that strives to provide patients a safe, supportive environment that fosters healing and facilitates a return to the highest possible level of independence.

As a Quality of Care Behavioral Health RN, you will support our Banner Health Plans. Our nurses, in this area, are required to complete Quality of Care and mortality reviews for the state- having prior Behavioral Health and Quality Management experience is essential for this role.

There is periodic travel to facilities in Arizona for health and safety checks (very rare but could be outside normal business hours); mileage reimbursement included.

Schedule - 7am-4pm or 8am-5pm

Opportunities to work remote 2-3 days a week!


Banner Corp Mesa
525 W Brown RD

Mesa, AZ 85201


Banner Corp Tuscon
2701 E Elvira RD

Tucson, AZ 85756

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

If you are a New Graduate Nurse with less than 12 months of experience, please apply to our New Nurse Experience openings.

  • --

About University Physicians Health Plans

The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care.

About Banner Health

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

  • --

Job Summary

The primary purpose of this position is to coordinate the investigation of quality of care concerns that have been referred to the Quality Management Department for review and resolution. The position is also responsible for assisting with education and training of health plan staff on the quality review process.

Essential Functions

  • Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database. Assists in preparation of Quality of Care reporting

  • Prepares Quality of Care cases for Peer Review as necessary and presents cases to Medical Director for review.

  • Participates in the collection and maintenance of data appropriate to the Quality Improvement Program. Implements and tracks provider corrective actions as necessary.

  • Participates in the preparation of routine and special reports, including the quarterly report, to the UAHN Board of Directors.

  • Assist in the development and implementation of the Organization wide UAHP Quality of Care training program.

  • Communicates the results of the monitoring and evaluation process to relevant individuals, or departments.

  • Identifies potential risk management and peer review problems in process of quality review for referral to the Risk Management and other appropriate staff.

Minimum Qualifications

Two years of clinical experience in an acute care setting; at least one year of quality improvement experience 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 and State Ambulatory and Acute Care Quality Improvement requirements and guidelines for JCAHO, NCQA, HEDIS, HCFA, and AHCCCS 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 UAHP support staff, providers, administrative staff and all other internal and external customers. Ability to make professional presentations to department heads, section chiefs, and to outside professional organizations is needed.

Preferred Qualifications

A B.S.N. is preferred.

Additional related education and/or experience preferred.

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Patient Care Manager(Team Leader)Home Health

LHC - Icims

Posted 5 days ago

VIEW JOBS 11/8/2018 12:00:00 AM 2019-02-06T00:00 OverviewAt Home Health Care, part of the LHC Group family, is looking for an RN Patient Care Manager for our Tucson location! LHC Group is the preferred post-acute care partner for hospitals, physicians and families nationwide. From home health and hospice care to long-term acute care and community-based services, we deliver high-quality, cost-effective care that empowers patients to manage their health at home. More than 60 leading hospitals and health systems around the country have partnered with LHC Group to deliver patient-centered care in the home. More hospitals, physicians and families choose LHC Group, because we are united by a single, shared purpose: It's all about helping people. The Home Health Patient Care Manager is responsible for the overall supervision and coordination of clinical services. Coordinates and supervises an interdisciplinary team of staff to assure the continuity of high quality care to home health patients assigned to the team's area in accordance with physician prescribed plan of care, and all applicable state and federal laws and regulations.Additional Details Essential Functions * Receives referrals and ensures appropriate clinician and|or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. * Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals. * Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance to physician orders. * Oversees and assures development, implementation, and updates to the individualized patient plan of care, as appropriate. * Manages and documents phone calls from physicians, clinicians, patients, referral sources, and communicates patient updates|new orders to clinicians. Uses coordination notes to document, as needed and appropriate. * Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate. * Coordinates all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other applicable healthcare providers. * Follows-up on lab and other clinical diagnostic test, physician contact, and significant changes in the patient condition to ensure adequate physician notification, follow-up, and needed plan of care modifications and communicates such to clinicians. * Schedules, prepares for, facilitates, and documents case conference/SOC reports and facilitates effective exchange of information across disciplines especially with adverse findings, changes in patient condition, daily and urgent updates, as necessary. * Assists clinicians in coordinating the transfer and discharge of patients from agency services as indicated by the physician. * Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs. * Processes new orders and updates the visit frequency, as appropriate, when the oncall RN takes supplemental verbal orders which alter frequency going forward. * Writes and processes orders when taking verbal orders directly from the physician and communicates such to field clinicians. * Assures payer change documentation is completed properly and timely, as required. * Reviews clinician visit notes weekly to ensure timely, complete, appropriate, and accurate submission of all documentation by field staff. Takes necessary action to correct adverse findings and communicates trending to branch manager. * Reviews, evaluates, and supervises service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews and case conferences. * Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy. * Assists in the orientation of new agency personnel. * Provides direction and leadership to clinical team members in collaboration with the branch manager and/or director. * Provides direct patient care, as necessary, in accordance to scope of practice and physician orders. * Participates in QAPI program. * Assures compliance with and ensures timely follow up on daily clinical and coding edits. * Directs clinicians in utilizing best practice interventions when finalizing Plan of Care for all patients. * Participates in on-call rotation. * Follows-up with On-Call events daily. * Receives report from weekend and after-hours clinicians admitting new patients. * Completes LHC required learning courses, additional assignments per DON request, as well as any state specific required training per state regulation/practice act requirements. * Directs team in adherence to and participates in the Episode Management process. * All other duties as assigned. QualificationsLicense Requirements * Current RN licensure in state of practice * Current CPR certification required * Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation LHC - Icims Tucson AZ

Health Plans Quality Of Care Behavioral Health Registered Nurse RN

Banner Health