This position provides strategic planning, advice and counsel, develops policies and maintains operational relationships with managed care organizations. This includes provider relations activities, health management processes, language development, negotiations, communication/training, resource development and support of claims collections that affect the strategic, tactical, and financial viability of the organization and its joint venture partners.
Establishes organizational standards for contract language, communication processes of contract terms, managed care education resources, and contract management and administration. Negotiates contract language to support legal, operational, and financial objectives of the organization.
Serves as team leader or key participant of regional operational groups that address activities related to managed care. These groups may include managed care organization claims and joint operating committees; hospital administrators and senior management managed care committees; the utilization management of the managed care operations group; organizational strategic initiative teams; change management committee.
Serves as liaison between managed care organizations and organizational entities on a broad range of managed care operations issues by facilitating problem resolution and developing and maintaining relationships with senior management representatives of both organizations.
Provides oversight and leadership for the maximization of the organizations financial performance by developing and implementing utilization and case management programs that interface with managed care organizations. This may include clinical program design within the contractual relationships with managed care organizations; overseeing implementation of the clinical program design by the organizations delivery system; problem resolution for operational issues that are both internal to the organization and external to managed care organizations; and preparation of managed care organization accreditation requirements.
Bachelors Degree in a relevant field or equivalent level of education and experience. Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five years of progressively responsible managerial experience, including a minimum of two years management level experience within a healthcare system setting or large multi-operational, complex corporate environment.
Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Drivers License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.
Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals. Must demonstrate skills and business acumen through direct leadership experiences such as: Anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.
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.