Job Details

Quality Oversight Coordinator

Location: 100% Remote AZ – CANDIDATE MUST RESIDE IN AZ SHIFT: Training M-F 8-5p – 1on1 setting – 4 weeks – no time off. Regular Schedule : M-F 8-5p AZ Duration: 90 days (possible extension and/or conversion)

Responsibilities

Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communication with agencies and providers. Collaborative culture. Key project to complete AHCCCS Medicaid QOC investigations. Systems – Word, teams, outlook, power point, excel, one drive, one note & specialized report system. Day-to Day Responsibilities: Receive 1-3 QOC investigations daily that are due 60 days from the assignment date. Reviewing medical records, provider policies/manuals and statutes to ensure providers are rendering appropriate care to our members per the guidelines. Writing an investigative report of findings and submitting reports. Expectation to complete 1 investigative report per day. The role is unique as it requires clinical knowledge to be able to identify quality concerns and develop quality improvement plan to address the concerns with the provider.

Candidate Requirements

Education/Certification - Required: Bachelor's degree in nursing or license (COMPACT IS OK) counselor/ SW preferred.

Licensure - Required: LPN, LVN, RN, PA, LPC, LAC or LCSW license. CPHQ (Certified Professional in Healthcare Quality) preferred.

Years of experience required: 3+ years of clinical, quality improvement or healthcare experience. MUST have BH or physical health setting experience. 2+ years of experience in quality function in a healthcare setting. Disqualifiers: No clinical BH or physical health experience

Additional qualities to look for: Self driven, fast learner, critical thinker

Top 3 must-have hard skills stack-ranked by importance - 1 - Clinical knowledge

2 - Critical thinker, independent work, tech savvy

3 - Self driven