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

A-Line

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