RN Quality of Care

Banner Health

. Support Banner Health Plans .

Posted 9/29/2026full-timePhoenix • Arizona • United StatesJuniorMid-Level💰 $33 - $55 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Quality of Care case management, including medical record review, compliance with National Medicare and State AHCCCS regulations, and effective communication with healthcare providers. Proven ability to analyze data, identify variances, and develop quality improvement initiatives while maintaining strong relationships with internal and external stakeholders.

Highest-signal resume keywords

RN LicenseQuality Management ExperienceKnowledge of AHCCCS RegulationsAnalytical Problem-Solving SkillsHealthcare Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewQuality Improvement Data ManagementData AnalysisCase TrackingCompliance Monitoring

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationRelationship Building

Tools & Technologies

AHCCCS PortalDatabase Management

Certifications & Qualifications

CPHQ Preferred

Industry Keywords

Quality of CareBehavioral HealthAcute CareOutpatient SettingRisk Management

About the role

Key responsibilities & impact

Support Banner Health Plans
Review medical records for quality of care cases
Use the AHCCCS portal to investigate concerns
Ensure compliance and support member safety
Triage new referrals assigned each week
Collaborate with providers and internal teams
Occasionally travel to conduct onsite health and safety visits in the Phoenix metro area
Investigate referred Quality of Care concerns, including medical record documentation review
Obtain provider responses
Prepare acknowledgment and closure correspondence
Track cases in a database
Prepare Quality of Care cases and present them to the Medical Director
Assist in developing and implementing the Banner University Health Plan Quality of Care training program
Communicate monitoring and evaluation results to the QOC Medical Director, QM Director, and QOC Supervisor
Identify potential risk management, FWA, and Compliance issues for referral
Coordinate care while maintaining quality standards and financial responsibility
Perform independently

Requirements

What you’ll need

Two years of clinical experience in an acute care or outpatient setting for Physical Health positions
At least two years of behavioral health experience and strong healthcare knowledge for Behavioral Health positions
Current, valid RN license in state of practice
Knowledge of National Medicare and State AHCCCS regulations
Excellent written and verbal communication skills
Strong analytical, problem-solving, concurrent and retrospective data management, and computer skills
Ability to identify variances from protocol
Ability to independently identify, develop, monitor, evaluate, report, and perform ongoing, objective, cyclic, and systematic QI indicator data
Ability to establish good working relationships with BUHP support staff, providers, administrative staff, and internal and external customers
Candidates must live in the Phoenix metro area
CPHQ preferred
Experience working in a quality management role preferred
Additional related education and/or experience preferred

Benefits

Comp & perks

Remote work opportunity after initial orientation and training
Flexible start times
Monday-Friday 8-hour shifts with no evenings or overnights
Training over Teams
Total rewards package