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Are you a experienced quality leader that can jump in and drive quality performance for AHCCCS lines of business. This position is flexible and remote working closely with all levels of leadership with in Banner
Banner Health offers a variety of benefits 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.
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 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.
CORE FUNCTIONS 1. Develops the vision necessary for the development of innovative quality programs for the health network. Provides oversight for the Credentialing Department.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Responsible for the development and monitoring of the annual Quality Improvement Annual Work Plan and evaluation.
8. 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.
9. Works independently under limited supervision. Manages all aspects of the function for the company. Has freedom to determine how to best accomplish functions within established procedures.
Required for successful performance in this position is a Bachelor's degree in Nursing, with a current licensure as a registered nurse in the State of Arizona, or a Master's 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.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health.
Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible.
The size, success and growth of our system provide you with the stability and options to pursue your desired career path.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.