Quality of Care Investigative Nurse (RN) - DS26-07340

NavitasPartners•Phoenix, AZ

15h•Onsite

About The Position

Navitas Healthcare, LLC is seeking a Quality of Care Investigative Nurse for an exciting Contract opportunity in Phoenix, AZ. This role involves conducting thorough investigations into quality-of-care concerns affecting members, reviewing medical records, developing corrective action plans, and ensuring compliance with state regulations and contractual obligations.

Requirements

Active and unrestricted Registered Nurse license in the State of Arizona required.
Minimum 6 months to 1 year of experience in risk management, quality assurance, nursing audits, quality improvement, investigations, or related healthcare compliance functions required.
Experience reviewing and analyzing medical records and healthcare documentation.
Strong knowledge of the nursing process, including assessment, monitoring, evaluation, and care coordination.
Proficiency with Microsoft Office Suite, databases, email systems, and electronic documentation platforms.
Excellent written and verbal communication skills.
Strong analytical, critical thinking, and problem-solving abilities.
Ability to prioritize multiple assignments and meet deadlines in a fast-paced environment.
Experience preparing professional reports, investigative summaries, and corrective action recommendations.

Responsibilities

Conduct timely, thorough, and member-centered quality-of-care investigations in accordance with DDD and AHCCCS requirements.
Review medical records, incident reports, care plans, and other relevant documentation to assess allegations and determine findings.
Investigate systemic and individual quality-of-care concerns affecting members.
Develop, implement, and monitor vendor-specific corrective action plans and remediation activities.
Maintain accurate, complete, and organized case documentation supporting investigative findings and substantiation levels.
Request, collect, and analyze documentation necessary for investigations and case reviews.
Upload investigative findings, supporting documents, and corrective action information into the AHCCCS Quality Management System (QMS) Portal.
Make referrals to appropriate oversight, regulatory, or protective agencies when warranted.
Participate in Care Concerns, Care Needed Today, and other assigned member-related issue reviews.
Monitor trends and identify recurring quality-of-care concerns, escalating issues to management as appropriate.
Collaborate with multidisciplinary teams to improve member outcomes and service quality.
Prepare professional reports, correspondence, and recommendations based on investigation outcomes.
Ensure compliance with state regulations, contractual obligations, and quality management standards.