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The Associate Director, RN Medical Management Services will lead a team of RN Utilization Management Care Reviewers and support the work in partnership with the Medical Director, to evaluate claims review and audit focus. You lead collaboration with Ambulatory Case Management and Facility Case Managers to ensure your staff is recommending safe and proper coordination upon discharge from facilities.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
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 the support and implementation of programs and tactics used to influence provider and Plan consumer/beneficiaries' behaviors in order to achieve right care in the right place at the right time and the appropriate cost. Plans and provides support for health plan consumers/beneficiaries to align with the objectives of triple aim. Plans and provides managerial leadership to team members within the department. This position supervises direct report personnel and participates in selection, orientation, counseling, evaluation and team scheduling. Promotes a collaborative, open and inclusive work environment in a highly matrixed organization. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes, provide oversight and coordination related to delivery of Medical Management services.
CORE FUNCTIONS 1. Provides and/or facilitates medical management and/or other related activities and serves as a resource to other team members. Promotes interdisciplinary health plan consumers/beneficiaries' care planning and supports Care Model.
2. Periodic On-Call availability to address after hour health plan consumers/beneficiaries' needs related to medical management.
3. Hires, trains, and conducts performance reviews, and directs the workflow for the team. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.
4. Evaluates and implements departmental processes to support Strategic Initiatives as determined by Banner Health Network.
5. Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes. Acts as a consultant within the organization and community.
6. Analyzes data and healthcare trends to gain efficiencies and improve health plan consumers/beneficiaries' outcomes. Acts as change agent to lead team through necessary modifications of processes, workflows, and/or delegated requirements.
7. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
8. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
9. This position is facility/entity based, providing leadership within medical management to ensure quality outcomes and resource efficiency. Internal customers include all levels of nursing leadership and team members, medical staff and all other members of the interdisciplinary healthcare team. External customers include physicians, payers, community agencies, provider networks and regulatory agencies.
Must possess a strong knowledge of nursing, case management or healthcare related field as normally obtained through the completion of a bachelor's degree or equivalent experience.
Requires current Registered Nurse (R.N.) license in state worked.
Requires extensive knowledge in the areas of case management and utilization management. Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources. Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. In BPA (Banner Plan Administration) setting, requires an understanding of reimbursement methodologies. Current Basic Life Support (BLS) certification.
Related certification(s) such as CCM, Certified Case Manager, MCG Certification(s), RN-BC Registered Nurse Case Manager, CMAC, Case Management Administrator preferred.
Additional related education and/or experience preferred.
DATE APPROVED 11/06/2016
Internal Number: R14214
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.