Job Description

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 other clinical matters. Responsibilities include: preparing and presenting written reports of review findings for various SHCA committees, SHCA behavioral health homes and state agencies; and providing ongoing technical assistance to provider agencies regarding clinical record completeness and quality.

Essential Duties and Primary Accountabilities:

Performs review of provider clinical records for quality, utilization and completeness based on state, federal and SHCA policy expectations.

Prepares and presents written reports of findings for SHCA committees, SHCA 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 SHCA committees and work teams as assigned.  Performs other duties of a similar nature and level as assigned.



Qualifications

Education:   

·         Active Arizona 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.

 

Work Related Experience:  

·         Knowledge in the areas of the Arizona behavioral health system including policies, procedures, and contract compliance; clinical and therapeutic best practices; AHCCCS, ADHS, and contract requirements, policies, and procedures; and SHCA 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;

 

Specialized Knowledge:  

·         Proficient and constant use of Microsoft Office products

·         Valid Arizona Drivers’ License

Application Instructions

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