Health care is changing, and it's our goal to create a new model to answer America's health care challenges today and in the future. Our passionate and talented teams will be the change on the health care landscape in our communities big and small. This is the perfect opportunity for a Registered Nurse with experience in population health strategies including quality, value based measures, and/or risk adjustment.
The Registered Nurse should have experience in developing collaborative relationships with physicians/APPs, strong communication skills, and be comfortable presenting information within a group setting. In this role you will have the opportunity to work alongside Medical Group Executive leadership while developing relationships with all Banner employees in a true collaborative integrated team model.
Your focus in this role will be workflows and operations and you would be responsible for multiple geographic areas in the west valley. You would have true collaboration amongst service line partners and high visibility with senior executives.
At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Loveland, Colo. and Torrington, Wyo., to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.
POSITION SUMMARY This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization's Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.) This includes collaborating with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs).
CORE FUNCTIONS 1. Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group. Coordinates the business design, testing and implementation of web-based RAF tools and reports in areas of expertise. Monitors and ensures tools are available post implementation. Responsible for the development and implementation of Risk Adjustment education and training for network physicians and practices, including documentation and coding requirements, HCCs, HEDIS quality ratings.
2. Establishes and promotes a collaborative relationship with physicians, third party vendors, and other members of the health care team. Collects and communicates pertinent, timely clinical information to third party vendors and others to fulfill utilization and regulatory requirements.
3. Assess accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately, with a goal to optimize the program's financial benefit to Banner Health.
4. Partners with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools. Provides formal training and supports physicians and practices in the day to day utilization of Risk Adjustment tools throughout Banner Medical Group.
5. Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools. Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution. Develops and implements recommendations to improve business processes to support and/or optimize RAF scores. Works collaboratively with ambulatory care management to ensure quality performance criteria expectations are disseminated so physicians and practices are equipped to meet and/or exceed clinical targets.
6. Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities. Meets regularly with BMG workforce team to review findings and develop an improvement plan to meet organizational goals. Partners with Risk Adjustment Quality Analysts and Educators to develop educational materials. Meets regularly with workforce teams to support communication and promote partnership.
7. Participates in or leads Risk Adjustment projects designed to improve program offerings or address system limitations. This may include analysis of BMG Practice Management systems, clearinghouse routing, vendor routing and/or CMS submissions.
8. Monitors data submission for attestation to CMS for Risk Adjustment. This position also analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance. Reviews, prepares, analyzes, and presents reports and as needed.
9. This subject matter expert role will interface on a regular basis with all levels at assigned facilities/entities. This position will also interact with both internal resources and external vendors.
MINIMUM QUALIFICATIONS Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience.
Must possess a current, valid RN license in the state of practice.
Must demonstrate effective relationship development skills, and ability to effectively communicate in individual and group settings. Teamwork is critical. Attentive listening and polished presentation skills are needed to effectively educate providers and practices on Risk Adjustment tools. Requires critical thinking and project management capabilities.
Position requires proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems.
PREFERRED QUALIFICATIONS 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.