Health Plans Licensed Practical Nurse LPN Auditor

** Department Name:
** Banner Staffing Services-AZ
*
* Work Shift:

** Day
* * Job Category:
** Risk, Quality and Safety
** Estimated Pay Range:**$26.40 - $44.00 / hour, based on location, education, &  accordance with State Pay Transparency Rules.

Banner Staffing Services (BSS) also offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a
** Licensed Practical Nurse (LPN)
** for
** Banner Health Plans**, you will be an integral part of the
** Health Plan Medical Management Team**. This assignment-based role focuses on independent chart review and clinical assessment.
** Key Responsibilities**:
* Independently review patient medical charts to assess whether the care provided may have contributed to the cause of death.
* Make initial determinations based on clinical findings and documentation.
* Forward reviewed charts to the broader Medical Management Team for further evaluation and action.
** Additional Details**:
* This is a
** Banner Staffing Services
** assignment-based position.
* ** Schedule**:
Monday–Friday, 8:00 a.m.–4:30 p.m.
* ** Expected Hours**: 40 hours per week
* ** Benefits**:
This role does
** not
* * include Medical or Paid Time Off (PTO) benefits.
* ** Assignment Duration**:
Length and hours are
** not guaranteed**.
** This is a fully remote position and available if you live in AZ only.
** This position is fully remote with travel less than 15% of the time to either a Banner corporate or hospital site.  With this remote work, candidates must be self-motivated, possess moderate to strong tech skills and be able to meet daily and weekly productivity metrics.
** As a valued and respected Banner Health team member, you will enjoy:
*** Competitive wages
* Paid orientation
* Flexible Schedules (select positions)
* Fewer Shifts Cancelled
* Weekly pay
* 403(b) Pre-tax retirement
* Employee Assistance Program
* Employee wellness program
* Discount Entertainment tickets
* Restaurant/Shopping discounts
* Auto Purchase Plan                                                                                   
** BSS Registry positions do not have guaranteed hours and no medical benefits package is offered**. BSS requires Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education).POSITION SUMMARY  This position coordinates and performs quality medical record reviews of the ambulatory medical record for PCP’s, OBGYN and High Volume Specialists (HVS). This position is also responsible for assisting the QM RN with the investigation and research of quality of care concerns that have been referred to the Quality Management Department for review and resolution.

In addition, the position is also responsible for abstracting medical records, analyzing data and importing data to ensure that all contract requirements and UAHN/MHP initiatives are completed successfully and timely.
CORE FUNCTIONS  
1. Assists in the development of clinical medical record audit tools and processes. Conducts data analysis using Microsoft Excel;
Requests, compiles, sorts, prepares, reviews, validates, and analyzes data extracted from , TCS, medical records and survey tools using statistically reliable sampling methods.
2. Coordinates, retrieves, and performs medical record audits to determine provider compliance with established AHCCCS standards for documentation in conjunction with the re-credentialing process.
3. Monitors and tracks Corrective Active Plans (CAPs), in collaboration with the Manager, Supervisor or QM RN and communicates audit results to providers along with education about best practices and recommendations for improvement as outlined in established guidelines.
4. Provides written documentation and Corrective Action Plans as directed by the Credentials Committee to providers when necessary, and coordinates communication with the Credentialing Department.
5. Reports potential risk or compliance issues identified in the audit process to the Manager/Supervisor of QM. Assists in the development of QM policies and desktop procedures. Provides input and feedback on opportunities for improvement;
Aggregates and analyzes medical record audit results on an annual basis for OFR required data. Participates in system-focused…