Primary City/State:

Phoenix, Arizona

Department Name:

Admin-Clinic

Work Shift:

Day

Job Category:

Nursing

University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics and has operations in multiple locations spanning across the Phoenix metropolitan city.

POSITION 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.

CORE FUNCTIONS
1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. The incumbent functions in a fast-paced healthcare environment with a wide variety of healthcare programs, activities, and settings. This position is accountable for all resources within the areas of operational responsibility to ensure standards are exceeded for customer service, financial management and regulatory compliance. Internal customers include employees at all levels within the organization, including system leadership. External customers include vendors, providers and government entities.

MINIMUM QUALIFICATIONS

Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelor’s 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.