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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.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
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.
Project Management experience preferred.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
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 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.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.