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Primary City/State:Phoenix, ArizonaDepartment Name:OperationsWork Shift:DayJob Category:General Operations and Culinary ServicesThe future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.Our high profile team is highly sought after as experts; we provide excellent customer service and we support each other in all of our roles. We are closely knit and innovative in our processes. In this role you will be managing a suite of vendors for the insurance division can include reviewing agreements for regulatory requirements, facilitating audits, reviewing policies, facilitating committee meetings, tracking progress and reporting on outcomes. Project Management experience, meeting facilitation, organization, reporting measures, strong follow up, audit experience, Medicare and Medicaid knowledge is a must, accreditation experience is a plus.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.This is a remote position in AZ. Local candidates only.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 SUMMARYThe primary purpose of this position is to plan, coordinate, implement and evaluate a delegation oversight team to prepare for ongoing federal and state accreditation requirements. This position acts as a subject matter expert to leadership and designated work groups related to regulatory requirements ensuring requirements are met for external delegates and Insurance division clients. Works both independently and collaboratively with all functional areas with the purpose to support development, implementation, maintenance, monitoring, and continuous improvement of delegation oversight. Must possess advanced organizational and matrixed management skills to manage the highly complex ongoing and periodic processes around delegation oversight and other regulatory requirements imposed by accreditation, federal or state organizations.CORE FUNCTIONSResponsible for the implementation of delegation oversight requirements using standardized processes within the PHSO. Prepares for federal, state or accreditation surveys by evaluating operational procedures for alignment with delegation oversight requirements. Reviews, evaluates and assists in the development and implementation of policies, procedures and guidelines as they relate to delegation oversight. Makes recommendations on all facility matters related to compliance with CMS and URAC and/or NCQA.
Ensures all regulatory, sub-regulatory and policy guidance are disseminated in a timely manner and that such guidance is strictly adhered to, implemented and monitored and that evidence of implementation is verified and documented. Conducts observations and document reviews and interviews to ascertain facility or department compliance with standards, rules and regulations. Documents findings and provides facility or department with reports and recommendations for change.
Provides oversight and management of delegation arrangements; including arrangements where Banner Plan Administration (BPA)/Banner Health Network (BHN) is delegated to provide services, and arrangements where BPA/BHN delegates services to another organization by collaborating with provider contracting.
Provides tools for ongoing measurement and reporting of compliance with delegation oversight standards. Supports development and monitors completion of facility plans of correction. Oversees and assists functional teams and department managers in the development of corrective actions. Manages or oversees the submission of all required materials and forms and data to the regulatory body overseeing a particular line of business.
Reports to senior leadership on compliance trends and recommends improvement strategies. Presents data and reports deficiencies identified during internal observations, and the status of implementation of action plans to senior leadership and at operational meetings. Reports facility or department readiness status on an ongoing basis. Manages the production of a Monthly Delegation Oversight Dashboard. Ensures functional areas are compiling and reporting the data that comprise the Monthly Delegation Oversight Dashboard.
Serves as primary liaison with delegates and clients. Serves as a subject matter expert on internal and external standards related to delegation oversight. Provides education to address delegation oversight changes and gaps in delegation compliance. Provides guidance to leaders and staff to ensure they understand delegation requirements. Serves on assigned committees, as chair or co-chair as appointed. Schedules and maintains delegation meetings, updating the committees on current and future plans and procedures, capabilities and actions.
Maintains delegation expertise through independent study as well as attending education workshops, tracking and reviewing regulatory changes, reviewing professional publications, establishing personal networks, and participating in professional societies. Participates and leads process improvement projects relating to accreditation activities or improvement of customer satisfaction.
Provides process/program management and coordination to Health Plan teams/work groups. Includes partnering with project and clinical leaders across the organization. Requires interactions with all levels of staff, management and physicians. This position interacts with a multitude of directors, managers and staff throughout the system. The diversity of areas includes department or other Banner executives, operational management and staff, staff and contracted physicians and clinicians, executives and managers with external partners or companies, including regulators and surveyors.
MINIMUM QUALIFICATIONSMust possess a knowledge as normally obtained through the completion of a Bachelor’s degree in health care administration, finance administration or project management or equivalent combination of work experience.The work requires a high degree of organization, the ability to manage time and resources effectively, and the self-starter ability to work independently to achieve goals. Effective customer service and interpersonal relations skills are necessary. Requires a strong knowledge of regulations and standards within area of focus as typically attained with 5 years relevant experience in a health plan setting, plus 3 years regulatory experience. Requires the ability to manage programs, projects and databases. Requires demonstrated excellence in interpersonal and written communication skills, plus the ability to teach new concepts to adult learners. Must possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophy. Must possess strong planning skills and problem-solving skills. Must possess strong oral and written communication skills to effectively interact with senior management team, physicians and federal and state governing and regulatory entities. Demonstrated ability to lead and facilitate interdisciplinary teams.PREFERRED QUALIFICATIONSHealth Plan experience and prior experience working in Medicare health plans preferred. Prior experience with in a surveyor or regulator role, experience in process improvement, regulatory/accreditation programs, health plan operations, and/or quality management preferred. Graphic development and presentations is also preferred.Additional related education and/or experience preferred.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
