Registered Nurse - Quality of Care Investigator

This role is part of the Quality Management Unit within the Division of Developmental Disabilities. The main responsibility is to conduct quality-of-care investigations in accordance with the contract with the Arizona Health Care Cost Containment System. The position involves investigating member-centric and systemic quality-of-care concerns to ensure the health and well-being of members.

The first day of work requires in-person attendance to obtain equipment and complete necessary security training for system access. Subsequent onboarding and training will be conducted remotely.

Key Responsibilities

• Conduct timely and thorough investigations of all quality-of-care issues related to division members.
• Implement vendor-specific corrective action plans using a standardized process.
• Make appropriate referrals to oversight and regulatory agencies.
• Participate in Care Concerns, Care Needed Today, and member issues as assigned.
• Maintain comprehensive documentation to support case work.
• Request and manage necessary documentation for investigations and ensure comprehensive case records are maintained.
• Issue remediation or a Corrective Action Plan to vendors as a result of investigations.
• Ensure all investigative information and documents are uploaded within the designated portal.
• Elevate cases and trend concerns to the supervisor as necessary.

Skills Required

• Critical thinking
• Technological proficiency, including the use of databases, Microsoft Office products, email, and electronic referral and verification sources
• Ability to produce professional technical reports and letters
• Research and analysis skills
• Strong oral and written communication skills
• Personal planning, organization, and time management
• Medical chart review
• Understanding of the Nursing Process, including assessment, monitoring, and evaluation
• Decision-making skills
• Ability to critically analyze problems and develop effective corrective action plans

Required Education

Candidates must possess and maintain an active license to practice as a Registered Nurse (RN).