| Primary City/State: Phoenix, Arizona Department Name: Value Based Performance Mgmt Work Shift: Day Job Category: General Operations The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. If you're ready to change lives, we want to hear from you. Join a role in the The Value Based Performance Management team which is at the forefront of driving risk based payer growth and differentiation in the Banner ecosystem by influencing contract performance, supporting member growth and harnessing payer insights 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 accountable for providing operational support and coordination of activities necessary to successfully manage payer value based products and relationships. Additional accountabilities include managing payer value based product outcomes, developing system standards and policies and procedures in alignment with the contractual agreement of the parties. These activities will be performed in concert with organizational strategic initiatives focusing on quality and financial outcomes of the program. Participates in development and implementation activities required to launch payer projects. Coordinates across all levels of the organization to implement solutions.
CORE FUNCTIONS
1. Serves as a project facilitator of value based arrangements focusing on implementation schedules, project charters, policies, procedures and programs as well as implementing and maintaining the payer products including related goals and objectives.
2. Reviews and analyzes reports of various activities to determine payer product progress toward stated goals and objectives.
3. This role is critical to facilitating the health care culture transformation from the current fee for service environment to value based population management models across a continuum of care. This includes but is not limited to assuring interfaces with payers in delivering population and medical management activities and tools such as case management, discharge planning, preadmission, concurrent and denial management activities.
4. Leads and manages JOC with payer. This entails interacting with internal and external customers and keeping abreast of managed care principles. Acts as a leader and resource in resolving complex management solutions with payer partners. This entails cultivating and maintaining positive relationships with managed care payers and employer groups maintaining open communications, and keeping abreast of market trends and industry changes.
5. Acts as Liaison between assigned payer and Banner Health. Monitors new payer projects to identify best practices and applies the practice to new populations and payer projects that are efficient, effective methods while ensuring compliance with payer guidelines. Identifies gaps in operations and implements solutions, implements ongoing project changes, and scales projects to broader geographic areas within or across all states.
6. Participates as member of Strategy development for assigned payer. Establishes communication, training and orientation tools for BH leaders related to ACO and payer projects.
7. Participate as member of negotiation team for assigned payer where required.
8. This position has responsibility for BHN activities that involve projects throughout the organization. Customers include leaders in the BHN, BH, hospital staff, physicians, payers, subcontracted network providers and consultants. This position is responsible for projects across multiple departments system-wide and requires interaction at all levels of staff and management. Requires work in context of multiple commitments, priorities and conflicts.
MINIMUM QUALIFICATIONS
Requires knowledge as typically obtained through the completion of a Bachelors degree in Business or Healthcare and five to seven years of experience in a managed care related field.
Must demonstrate critical thinking skills, problem-solving abilities, effective verbal and written communication, and time management skills to engage clinical and non-clinical audiences. Must demonstrate ability to work effectively in an interdisciplinary team forum. Must have skills to mentor and educate clinical and non-clinical teams to transform health care to a population health model. Requires sound clinical judgment and an understanding of managed care concepts. Requires excellent customer service skills and a sense of urgency and ownership for resolving issues.
PREFERRED QUALIFICATIONS
Project Management experience preferred.
Additional related education and/or experience preferred. |
