Registered Nurse Manager-Population Health

Banner Health - Sun City West, AZ

Full-time
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Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

As a Registered Nurse Manager, you will Serves as a program facilitator for value based arrangement so having insurance experience is a must. This position facilitates programs related to medical management, performance-based arrangements, and managed care programs. Interfaces with all levels of staff, health plans and physicians. The position leads a teams of staff that support the practices, providers and ultimately the patients, this position will be located in the west valley in Sun City West corporate office. Schedule will be Monday-Friday day shift. This postion requires a BSN degree, if not currently obtained needs to be completed within 6 months of date of hire.

At Banner we’re creating a world class medical organization that brings together a leadership team committed to a physician-focused structure, while navigating the challenges of moving from a volume-based to value-based health care system.

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.

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About Banner Medical Group
At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Loveland, Colo. and Torrington, Wyo., to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent 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.

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Job Summary

This position facilitates programs related to medical management, performance-based arrangements, and managed care programs. Interfaces with all levels of staff, health plans and physicians. Develops processes and implementation activities required to launch payer projects. Coordinates across all levels of the organization to implement solutions. This may include oversight of national and commercial performance measures, including but not limited to Medicare Stars Rating (Stars), Healthcare Effectiveness Data and Information Set (HEDIS), Accountable Care Organization (ACO) measures and Risk Adjustment Factor (RAF) metrics for Medicare Advantage and Commercial business.

Essential Functions

Serves as a program facilitator for value based arrangement. Facilitation includes the development of implementation schedules, procedures and programs as well as implement and maintain the payer products including related goals and objectives. Ensures compliance with federal and state regulations, as well as established organizational policies and procedures.

Participates in the development and implementation of select payer programs, short and long-range goals and objectives and determines the optimal progression to obtain these goals. Reviews analyses and reports of various activities to determine progress toward goals and objectives.

Reviews, prepares, analyzes, and presents reports and recommendations to senior management to provide concise and accurate information that aids in decision-making. Develops, reviews, and monitors financial outcomes using performance metrics.

Acts as Liaison between assigned payer and the business. Monitors projects to develop best practices and identify process that are efficient and effective methods while ensuring compliance with payer guidelines. Identifies gaps in operations, implements solutions, and developing ongoing project changes.

Ensures risk adjustment (RA) accurately reflects the membership health profiles, as well as completeness of the Medicare risk adjustment data, to ensure compliance with all Centers for Medicare and Medicaid Services (CMS) regulations and guidelines.

Develops and maintains documentation to support consistent and accurate administration of the Risk Adjustment and Quality processes. Maintains a current professional and technical knowledge relating CMS and payer requirements and directives for Risk Adjustment and Quality to ensure policies and procedures meet compliance requirements.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Medical Group with an excellent service experience by consistently demonstrating our core and leader behaviors each day.

Minimum Qualifications

Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration or related field.

Current license as a Registered Nurse.

Proficiency typically achieved with five or more years of RN experience in health care or managed care related field. Requires proven record of leading meetings, presenting to groups, ability to build consensus and implement advanced business solutions. Requires thorough familiarity with workflow and process improvement applicable to a healthcare setting, along with prior project management experience.Must possess strong oral, written and interpersonal communication skills to effectively interact with all levels in the organization. Ability to function effectively in a team oriented, fast-paced environment. Position requires proficiency in personal software applications, including word processing, generating spreadsheets, and creating graphics/presentations. 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 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 risk adjustment and managed care concepts.

Preferred Qualifications

Additional related education and/or experience preferred.