Senior Specialist, Health Plan Quality Prog Mgmt & Perf (RN)

JOB DESCRIPTION Job Summary Provides senior level clinical support to quality team - contributing to quality management programs, initiatives, audits, data analysis and quality improvement surveys and state/federal quality compliance activities. Contributes to overarching strategy to provide safe, efficient and cost-effective member care. *Must reside in Arizona* Essential Job Duties • Ensures individual and systemic quality of care investigations are performed timely, accurately, and in accordance with state-based requirements. • Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities. • Performs quality monitoring activities, including audits of medical record quality, services and service sites, health and safety, and follow-up monitoring of placement settings. • Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and ...