Primary City/State:

Phoenix, Arizona

Department Name:

Health Plan Mgmt

Work Shift:

Day

Job Category:

General Operations

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position is responsible for developing long and short-term business strategies and overseeing all planning and coordination of market initiatives and operational programs related to Risk Adjustment for Banner Health Plans and Networks. Responsible for the ongoing development, implementation, and facilitation of processes to assure that all pertinent clinical information impacting the risk scoring of patients is captured and transmitted to appropriate entities for both Banner Health Plans and Networks. Leads market initiatives and supports teams engaged in patient outreach, documentation integrity, and clinician education and tools. Full accountability for risk adjustment teams within assigned regions. The incumbent is the subject matter expert (SME) that provides guidance for provider and vendor related issues and overall program management for the risk adjustment programs including, but not limited to, retrospective, prospective and concurrent initiatives.

CORE FUNCTIONS

1. Serves as the primary advisor to the organization’s senior management; Leads leaders or high-level individual contributors.

2. Develops and oversees the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.

3. Influences the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Influences internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.

4. Actively participates in setting the strategic direction for functional area(s) and provides direction and support to ensure execution of operations, programs, services, and/or other applicable areas.

                                                                                                                             

MINIMUM QUALIFICATIONS  

Bachelor's Degree in applicable field.

                   

Significant technical and managerial experience, typically gained through seven plus years of relevant experience.

Seven plus years of management and leadership in risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry.       

PREFERRED QUALIFICATIONS

Previous experience in value-based revenue and quality improvement initiatives with various health insurance product(s) preferred. Previous managed care or Medicare experience preferred.       

                                                                                                                       

Additional related education and/or experience preferred.      

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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