| Primary City/State: Phoenix, Arizona Department Name: HP Statewide Quality Work Shift: Day Job Category: General Operations Great careers are built at Banner Health. We understand that talented health care professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices throughout our network of facilities. Apply today, this could be the perfect opportunity for you. This is a job is tremendously rewarding as we ensure that our members receive the care and services they need and deserve. Your pay and benefits are important components of your journey at Banner Health. 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. Banner University Health Plans (BUHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee. POSITION SUMMARY This position coordinates the investigation of quality of care concerns for Banner University Health Plan members that have been referred to the Quality Management Department for review and resolution. CORE FUNCTIONS 1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database. 2. Prepares Quality of Care cases and presents cases to Medical Director for review. 3. Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program. 4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor. 5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff. 6. This position makes decisions that facilitate smooth coordination of care to ensure member's care needs are met while maintaining quality standards in a financially responsible manner. Performs independently. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. MINIMUM QUALIFICATIONS Two years of clinical experience in an acute care or outpatient setting; at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required. Requires a Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW); a Licensed Professional Counselor (LPC) or Licensed Associate Counselor (LAC), a Licensed Marriage and Family Therapist (LMFT) or an Licensed Associate Marriage and Family Therapist (LAMFT), a Licensed Independent Substance Abuse Counselor (LISAC) or a Licensed Associate Substance Abuse Counselor (LASAC). An equivalent license applies to states that do not recognize an LCSW or others as specified; therefore, the employee must possess a Master's Degree and be a Licensed Social Worker, Counselor, Marriage and Family Therapist or Substance Abuse Counselor. Knowledge of National Medicare and State AHCCCS regulations is required. Excellent written and verbal communication skills, strong analytical, problem solving, concurrent and retrospective data management and computer skills are necessary. The ability to identify variances from protocol and the ability to work independently to identify, develop, monitor, evaluate, report and perform ongoing, objective, cyclic, and systematic QI indicator data, and the ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff and all other internal and external customers. PREFERRED QUALIFICATIONS A CPHQ is preferred. Additional related education and/or experience preferred. | .png?sfvrsn=8cb5512c_0 "ACA(WEBusage)")
