Job Information
Banner Health Associate Director, Registered Nurse RN Care Management Remote Phoenix Arizona Metro in Arizona, Arizona
Primary City/State:
Arizona, Arizona
Department Name:
Health Mgmt
Work Shift:
Day
Job Category:
Clinical Care
Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today.
Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN.
As an Associate Director Registered Nurse RN Care Management, you will call upon your background in Leadership and Complex Case Management or Utilization Medical Managment to oversee the Banner Aetna line of business. You will attend meetings with payers, oversee the RN and Social Workers' daily operations, maintain payer and NCQA requirements, monitor operation metrics, and create action plans as necessary to course correct. You will partner with other departments and leaders and attend special events as needed.
Your work location will be 80% remote and 20% in the field or at the Banner Mesa Corporate Offices. Your salaried work week will primarily be Monday-Friday 8:00 a.m.-5:00 p.m. with some days needing longer or other hours. This role does require Phoenix Arizona Metro residency for compliance and hybrid work location needs. If this role sounds like the one for you, Apply today!
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 plans and provides managerial and/or clinical, behavioral, counselling support to members, staff and leadership within the department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes related to delivery of Care Management services.
CORE FUNCTIONS
Provides and/or facilitates care management and/or other related activities and serves as a resource to other staff members. Promotes interdisciplinary patient care planning and supports Care Model. Assists staff in the management of individual members across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Hires, trains, conducts performance evaluations, and directs the workflow for the staff. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.
Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities within the department. Works with staff to make necessary changes. May analyze data and healthcare trends to gain efficiencies and improve patient outcomes.
Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
Oversees and is responsible for the quality of RN assessments. Assists with payer audit process surrounding NCQA, URAC, or any other regulatory agency requirements.
This position is regionally based, providing leadership within care management to ensure quality outcomes and resource efficiency. Internal customers include all levels of nursing leadership and staff, medical staff and all other members of the interdisciplinary healthcare team. External customers include physicians, payers, community agencies, provider networks and regulatory agencies.
MINIMUM QUALIFICATIONS
Bachelor’s Degree in Nursing with three years of experience directly related to care management in health plan/mgmt./quality.
Requires current Registered Nurse (R.N.) license in state worked.
Requires extensive knowledge in the areas of care management and utilization management.
Must have a working knowledge of ambulatory operations, hospital and community resources.
Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations.
Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.
In BPA (Benefits Plan Administration) setting, requires an understanding of reimbursement methodologies.
PREFERRED QUALIFICATIONS
Certification with nationally recognized healthcare organization, such as CCM, preferred.
Additional related education and/or experience preferred.
EOE/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)
Our organization supports a drug-free work environment.
Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)
EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability