Clinical Quality Investigator
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: This position is responsible for the review of provider clinical records for quality, utilization and completeness; and conducting clinical investigations, reviews, and developing recommendations about quality of care, mortalities and clinical best practices. Responsibilities include: preparing and presenting written reports of review findings for various HCA committees, HCA behavioral health homes and state agencies; and providing ongoing technical assistance to provider agencies regarding quality of care and patient safety.
- Performs review of provider clinical records for quality, utilization and completeness based on state, federal and HCA policy expectations.
- Prepares and presents written reports of findings for HCA committees, HCA behavioral health homes and for state agencies.
- Provides ongoing technical assistance to provider agencies regarding clinical record completeness and quality.
- Performs clinical oversight functions such as reviewing of criteria-based clinical activities, processes or programs for adherence to established standards or criteria, and/or information gathering.
- Conducts clinical investigations, reviews and develops recommendations about quality of care, mortalities and other clinical matters.
- Participates on HCA committees and work teams as assigned.
- Conducting ad hoc on-site health and safety checks at provider locations.
- Performs other duties of a similar nature and level as assigned.
- Some travel is required.
Education / Experience / Other Requirements
- A Master’s degree in counseling, social work, psychology or related field.
- An Arizona behavioral health professional license or an Registered Nurse (RN) license
Years of Experience:
- Two years of related experience; or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position.
- Knowledge in the areas of the Arizona behavioral health system including policies, procedures, and contract compliance; clinical and therapeutic best practices; AHCCCS, and contract requirements, policies, and procedures; and HCA clinical and safety policies and procedures.
- Additional skills in the following areas are also necessary for this position: problem resolution, prioritizing, and handling multiple projects
- Ability to maintain confidentiality, privacy, and security of protected information
- Effective, professional, and appropriate communication both verbally and in writing
- Ability to work effectively and efficiently both independently and as part of a team
- Proficient and constant use of Microsoft Office products
- Valid Arizona Drivers’ License