| Primary City/State: Phoenix, Arizona Department Name: Health Mgmt Work Shift: Day Job Category: Clinical Care Help move health care into the future. At Banner Health we are changing health care to make the experience the best it can be. If that sounds like something you want to be part of, apply today. 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 plans and provides managerial and/or clinical, behavioral, counselling support to members, staff and leadership within the department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains a depth and breadth of Medicaid and Medicare long-term care case management competency and/or managed care knowledge to assess outcomes related to delivery of Case Management services.
CORE FUNCTIONS
1. Provides and/or facilitates Medicaid and Medicare case management and/or other related activities and serves as a resource to other staff members. Promotes interdisciplinary member care planning and supports Care Model. Assists staff in the management of individual members across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, cost-effective and satisfaction outcomes.
2. Hires, trains, conducts performance evaluations, and directs the workflow for the staff. 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.
3. Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities within the department. Works with staff to make necessary changes. May analyze data and healthcare trends to gain efficiencies and improve patient or member outcomes.
4. 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.
5. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
6. Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.
7. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
8. This position is regionally based, providing leadership within case management to ensure quality outcomes and resource efficiency. Internal customers include all levels of nursing leadership and staff, medical staff and all other members of the interdisciplinary healthcare team. External customers include physicians, payers, community agencies, provider networks and regulatory agencies.
MINIMUM QUALIFICATIONS
Requires a bachelor's degree in nursing, social work or equivalent experience.
Three years of experience directly related to case management in health plan/mgmt./quality.
Requires extensive knowledge in the areas of Medicaid and Medicare managed care practices and policies, including care management and utilization management. Must have a working knowledge of ambulatory and community operations, hospital and community resources. Supervisory or lead experience required. 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.
PREFERRED QUALIFICATIONS
Certification with nationally recognized healthcare organization, such as CCM, preferred.
Additional related education and/or experience preferred. DATE APPROVED 05/05/2019 |
