Registered Nurse

Job Description – Registered Nurse (RN) – Quality of Care Investigative Nurse

Location: Phoenix, Arizona 85012

Work Arrangement: Hybrid (Primarily Remote)

Contract Duration: (approximately 2.5 months)

Working Hours: 40 hours/week

Schedule: Monday–Friday, 8 AM–5 PM

Weekend: No weekends

Travel: Not Required

First Day Onsite for equipment collection and security training Remaining Work Primarily Remote

Job Summary:

The Quality of Care Investigative Nurse will work within the Quality Management Unit.

The primary responsibility is to investigate member-related and systemic quality-of-care concerns, review medical records, identify potential gaps in care, analyze evidence, and prepare detailed investigative reports.

The ideal candidate should have strong nursing knowledge combined with experience in quality assurance, risk management, clinical auditing, utilization review, regulatory compliance, or patient safety.

This role focuses more on investigation, analytical skills, and professional report writing than direct bedside patient care.

Key Responsibilities:

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• Conduct thorough investigations into member-centric and systemic quality-of-care concerns.
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• Review medical records, clinical documentation, and healthcare-related reports.
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• Analyze information from multiple sources and identify inconsistencies, trends, and potential care deficiencies.
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• Gather and evaluate supporting documentation for investigations.
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• Determine the appropriate level of substantiation for reported allegations.
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• Prepare detailed, professional, and defensible investigative reports.
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• Develop and issue corrective action plans (CAPs) to healthcare vendors when necessary.
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• Upload investigative documentation and findings into the AHCCCS Quality Management System (QMS) Portal.
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• Identify cases requiring escalation and communicate concerns to the QOC Supervisor.
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• Make appropriate referrals to regulatory and oversight agencies.
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• Participate in Care Concerns, Care Needed Today, and other assigned member-related investigations.
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• Maintain accurate and comprehensive case documentation.
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Required Qualifications:

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• Active Arizona Registered Nurse (RN) license.
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• Strong clinical judgment and critical-thinking skills.
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• Experience reviewing medical charts and clinical documentation.
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• Ability to investigate complex healthcare cases.
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• Ability to analyze information from multiple sources and reach evidence-based conclusions.
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• Strong written and verbal communication skills.
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• Professional report-writing and documentation skills.
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• Proficiency in Microsoft Office, databases, email, and electronic healthcare systems.
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Preferred Qualifications:

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• Bachelor's degree in Nursing (BSN), Master's degree, or Doctoral-level education.
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• 6 months to 1 year of experience in any of the following:
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• Quality Assurance (QA)
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• Risk Management
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• Clinical Auditing
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• Quality-of-Care Reviews
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• Regulatory Compliance
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• Utilization Review
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• Patient Safety
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• Experience preparing formal investigative reports.
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• Experience conducting clinical research.
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• Experience evaluating healthcare compliance with clinical standards.
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• Experience analyzing complex cases involving extensive medical records and supporting evidence.
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Submission Documents:

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1. Updated Resume (must mention current location).
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2. Level 1 Fingerprint Clearance Card (FPCC).
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3. Active Arizona RN License.
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4. CPR/BLS Card.
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5. TB Skin Test.
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6. Driver's License.
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