Primary City/State:

Phoenix, Arizona

Department Name:

Clinical Decision Making

Work Shift:

Day

Job Category:

Physicians

Help move health care into the future. At Banner Health we are changing health care to make the experience the best it can be. If that sounds like something you want to be part of, apply today.

Phoenix is Arizona’s major city and the fifth most populated city in the United States. It includes the posh resorts and green golf courses of Scottsdale, Tempe’s lively college-town vibes, arts-friendly Mesa and pro-sports hub Glendale, several American Indian tribal lands, and the suburban cities of Chandler and Gilbert.

As a Medical Director of Network Performance, you will meet with physician groups to help transform their practice of medicine from fee for service approaches, to value based approaches. You will attend internal meetings with IT/finance/network to discuss support structures for improvement. Having a background in value based care, specifically understanding how to work with physician practices and medical groups around performance improvement in the areas of HEDIS/STARs/quality score improvements, lowering medical costs, improving the patient experience, improving documentation of illness burden (RAF/HHS/CDPS+Rx) will be most helpful in this position. You will be able to work from home for internal meetings, Physician meetings are onsite.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

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 serves as the senior physician for the Banner Health Network (BHN) independent physician network(s) within a given region/geography and collaborates/influences key stakeholders in the implementation of strategic priorities and achievement of the broader organization’s (Banner Health Insurance Division’s) goals, objectives and driving strategies by demonstrating committed and enthusiastic support of the value-based model of patient centered care. Guides development of healthcare strategy, particularly related to the engagement, integration, and development of clinical programs with independent providers. Owns accountability for the quality and appropriateness of care provided by clinicians across the BHN and for the accurate and timely documentation of such care to drive measurable evidence of appropriate resource utilization, clinical quality, and service outcomes. This position will also participate in the development of standards governing the availability of services within the various plans according to regulations; will recommend operational changes to reflect such standards and shall direct the medical operations to achieve improved revenue through improvement in the risk adjustment program and quality programs. Working with Insurance Division leadership, this role is responsible for overseeing the quality and risk adjustment programs that includes overseeing coding, education, data aggregation, provider and network reporting, and payer interactions. This physician leader will strive to create a culture of continuous quality improvement with key stakeholders, and will advocate for creation and maintenance of programs designed to reduce the administrative burden placed on independent providers participating in our value-based programs and participating in our various owned insurance products. Devise and review statistical reports relating to patterns of care on hospital utilization and practice patterns of physicians and create recommendations for follow-up procedures.

ESSENTIAL FUNCTIONS
1. Serves as the primary advisor to the organization’s senior management; Leads leaders or high-level individual contributors

2. Develops and oversees the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.

3. Influences the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Influences internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.

4. Actively participates in setting the strategic direction for functional area(s) and provides direction and support to ensure execution of operations, programs, services, and/or other applicable areas

MINIMUM QUALIFICATIONS

Medical Doctorate or Doctor of Osteopathy Degree required with appropriate Board Certification or qualification of clinical practice experience.

Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver’s License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.

Must possess a strong knowledge and understanding of managed care operations, reimbursement models, medical protocols and criteria, and peer review statutes as normally obtained through 5 years of medical practice experience. Must possess a current knowledge of clinical protocols, reimbursement challenges, and managed care principles. Must possess excellent oral, written and interpersonal communication skills to effectively interact with all levels within the organization, as well as outside parties. Experience with hospital organized medical staff, managed care organizations, and continuous quality improvement activities. Proven experience and track record of predicting the futuristic relevancy and applicability of innovative industry trends, both technological and programmatic. Proven track record leading physician groups, including group facilitation, leadership development, team-building, performance management, and driving cultural change. Experience working with physicians to strategize and develop measurable improvements the quality of clinical care and patient satisfaction. Proven experience implementing a continuous improvement culture. Experience implementing and maintaining a patient-centered, healing culture. Proven track record of partnering with physicians to achieve desired organizational outcomes. Knowledge of modern national trends in health care technology, quality and patient safety. Knowledge of health care reform, population health management, and ACO trends and developments. Skilled in effectively handling multiple conflicting assignments, demands, and priorities with great attention to detail; coaching and developing direct reports and/or other employees by providing open and honest feedback that results in enhanced performance outcomes; establishing, pursuing, and monitoring appropriate process and outcome measures for key initiatives utilizing a systems perspective; evaluating the processes by which clinical care and patient services are delivered, identifying areas for of opportunity, setting standards for outcomes, developing appropriate systems to monitor outcomes, and overseeing the implementation of process improvements; quickly assessing and assimilating industry trends in order to act quickly and appropriately to changing environmental factors; influencing others and translating strategies into actions; motivating physicians and building teams; influencing physician behaviors; partnering and problem solving with physicians and hospital and practice management leaders. Excellent human relations, organizational and communication skills are essential. Leadership style and characteristics necessary to effectively perform in this role include: strong work ethic; results-oriented; persuasive; motivational; able to make rational decisions in difficult situations; inspirational; honorable; confident; systems-thinker; innovative; life-long learner; courageous; high-energy; integrity; collaborator; ability to work with teams; good listening; nonvolatile; values multiple disciplines; and passionate about continuously improving and providing high quality care and service excellence to patients, families, employees and physicians.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Privacy Policy