Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

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.

Responsibilities:

  • 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

Education:   

  • 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.

Specialized Knowledge:  

  • 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

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online