This position is accountable for providing operational support and coordination of activities necessary to successfully manage payer value based products and relationships. Additional accountabilities include managing payer value based product outcomes, developing system standards and policies and procedures in alignment with the contractual agreement of the parties. These activities will be performed in concert with organizational strategic initiatives focusing on quality and financial outcomes of the program. Participates in development and implementation activities required to launch payer projects. Coordinates across all levels of the organization to implement solutions.
Serves as a project facilitator of value based arrangements focusing on implementation schedules, project charters, policies, procedures and programs as well as implementing and maintaining the payer products including related goals and objectives.
Reviews and analyzes reports of various activities to determine payer product progress toward stated goals and objectives.
This role is critical to facilitating the health care culture transformation from the current fee for service environment to value based population management models across a continuum of care. This includes but is not limited to assuring interfaces with payers in delivering population and medical management activities and tools such as case management, discharge planning, preadmission, concurrent and denial management activities.
Leads and manages JOC with payer. This entails interacting with internal and external customers and keeping abreast of managed care principles. Acts as a leader and resource in resolving complex management solutions with payer partners. This entails cultivating and maintaining positive relationships with managed care payers and employer groups maintaining open communications, and keeping abreast of market trends and industry changes.
Acts as Liaison between assigned payer and Banner Health. Monitors new payer projects to identify best practices and applies the practice to new populations and payer projects that are efficient, effective methods while ensuring compliance with payer guidelines. Identifies gaps in operations and implements solutions, implements ongoing project changes, and scales projects to broader geographic areas within or across all states.
Participates as member of Strategy development for assigned payer. Establishes communication, training and orientation tools for BH leaders related to ACO and payer projects.
Participate as member of negotiation team for assigned payer where required.
Requires knowledge as typically obtained through the completion of a Bachelors degree in Business or Healthcare and 5-7 years of experience in a managed care related field.
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 demonstrate ability to work effectively in an interdisciplinary team forum. 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 managed care concepts. Requires excellent customer service skills and a sense of urgency and ownership for resolving issues.
Project Management experience preferred.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •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 system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •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. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.