• Health Plan Quality Director

    Job Number
    232152
    Facility
    Banner Plan Administration Inc
    Department
    Clin Perform Assmt-Amb
    Address : Location
    US-AZ-Phoenix
    Work Schedule
    Day
    Position Type
    FT: Full-Time
    Posting Category
    Leadership - Non-Clinical
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    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 Quality Director of the Insurance Division, there will be exciting opportunities to be part of the health care transformation. 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. 

     

    Schedule:

    Monday-Friday; 8:00AM-5:00PM

    Opportunities to work 1/2 days remote

     

    Location:

    525 W Brown RD

    Mesa, AZ 85201

     

    Your pay and benefits are important components of your Journey at Banner Health. This opportunity is also eligible for our Management Incentive Program, as part of your Total Rewards package. 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 Health Network & Banner Plan Administration
    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.

     

    Truven-2013
    Stage7-2013

    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

    The primary purpose of this position to provide vision, leadership and direction in the development, implementation and evaluation of The University of Arizona Health Plans Quality Program. The Director of Quality Management will provide oversight for program development, program implementation, and program compliance. Areas of responsibility include: oversight of Performance Measures and the design of strategies to improve performance, oversight of Quality of Care processes, oversight of the HEDIS reporting and the NCQA Structure and Process Measures, and responsibility for all reporting to the QM/PI Committee. The Director of Quality will supervise the Credentialing department.


    Essential Functions

  • Develops the vision necessary for the development of innovative quality programs for the health network. Provides oversight for the Credentialing Department.

  • Provides oversight to the Quality of Care (QOC) process; including documentation of issues, review of pertinent medical information, collaborate with the Quality of Care Committee, provide education to vendors, providers, and staff, assists in the implementation of process improvement projects, and tracks and trends associated data.

  • Oversees all reporting to the Quality Management / Performance Improvement (QM/PI) Committee and associated reporting processes. Develops and facilitates implementation of disease / condition-specific population management related member outreach, community education, and provider education / training related to selected conditions and health promotion initiatives.

  • Responsible for preparation of all required Quality Management, HEDIS and HOS reports. Is the key contact with the HEDIS vendor and auditor for all data submission issues.

  • Provides direction for the development, implementation and reporting on required Performance Improvement Projects, including the identification of opportunities for improvement, corrective actions and assessing outcomes of implemented interventions.

  • Oversees the process for conducting clinical site audits, medical record audits as well as the reporting of the findings and data tracking and trending. Collaborates with clinical staff on corrective action implementation as necessary.

  • Responsible for the development and monitoring of the annual Quality Improvement Annual Work Plan and evaluation.

  • Ensures that regulatory requirements for the Quality Management Program are followed, reviewed and revised based on changes in state/federal rules and regulations or an identified need of members or providers.

  • Minimum Qualifications

    Required for successful performance in this position is a Bachelors degree in Nursing, with a current licensure as a registered nurse in the State of Arizona, or a Masters degree and Certified Professional in Healthcare Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers. Director level experience in healthcare management, with at least five years of experience in a quality/utilization management leadership role, is required.

    Direct experience overseeing quality improvement processes and knowledge of the requirements of national/state accrediting agencies, such as NCQA, HEDIS, Medicare (CMS) and Medicaid (AHCCCS) is required. Demonstrated knowledge and experience in the development and implementation of clinical and operational information systems that support staff operations and reporting is needed. Strong analytical skills and data management skills are required. Excellent communication skills are required.

    The ability to work in a cross-departmental collaboration model is required. The ability to build consensus and ensure continuous feedback on process and progress is critical. The ability to prepare and deliver presentations is required, as is the ability to recommend realistic courses of action and operational changes as a result of data analysis.

    Preferred Qualifications

    Additional related education and/or experience preferred.

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