At Banner Health, we believe that ???leadership matters??? and is a key component to providing excellent patient care. Join a nationally recognized leader that values excellence, and begin making a difference in people???s lives.
As a Health Plan Quality of Care Team member you will support our??Banner Health Plans.??Banner Health Complete Care- a plan that will be focused on the integration of physical health and behavioral health.?? We are known nationally as an innovative leader in new health care models, where insurance plans and physicians come together to work collaboratively to make things easier for the member.?? The division serves over 500,000 members in our community.??
Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans 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 University Health Plans (BUHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. ?? About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
POSITION SUMMARY This position coordinates the investigation of quality of care concerns for Banner University Health Plan members that have been referred to the Quality Management Department for review and resolution.
CORE FUNCTIONS 1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database.
2. Prepares Quality of Care cases and presents cases to Medical Director for review.
3. Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program.
4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor.
5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff.
6. This position makes decisions that facilitate smooth coordination of care to ensure member???s care needs are met while maintaining quality standards in a financially responsible manner. Performs independently.
Two years of clinical experience in an acute care or outpatient setting; at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required
Must possess a current, valid RN license in state of practice.
Knowledge of National Medicare and State AHCCCS regulations is required. Excellent written and verbal communication skills, strong analytical, problem solving, concurrent and retrospective data management and computer skills are necessary.
The ability to identify variances from protocol and the ability to work independently to identify, develop, monitor, evaluate, report and perform ongoing, objective, cyclic, and systematic QI indicator data, and the ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff and all other internal and external customers.
A CPHQ is 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.