Easter Seals Jobs

Primary City/State:

Arizona, Arizona

Department Name:

Medicare FFS ACO

Work Shift:

Day

Job Category:

General Operations

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. If you’re looking to leverage your abilities – you belong at Banner.

Recognized nationally as an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members in optimal health. Known for our innovative, collaborative, and team-oriented approach, BPN offers a variety of career opportunities and innovative employment options by offering remote and hybrid work setting.

In the role of Senior Payor Accounts Program Consultant for Banner Plans & Networks, you will leverage your Managed Care expertise to represent Banner Plans and Networks to Payers and Internal Stakeholders. You will own the relationship with payers and represent BPN in meetings. You will call upon your in depth understanding of Banner’s operational processes to inform and respond to questions/concerns raised in collaborative payer meetings. You will collaborate with operational team members and leaders to identify opportunities for performance improvement by providing consistent data that allows all stakeholders to monitor and improve performance.

The position allows for completely remote work. Alternatively, if you are in the Phoenix, Arizona Metro Area, you have the option to work from the Banner Corporate Offices. The work schedule is Monday to Friday, adhering to Arizona's business hours. This is a salaried position, exempt from overtime. If you're interested in this role, please apply today!

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

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, leading the development of 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 by overseeing operational activities and owning the process for monitoring performance in value-based contracts across multiple payers

CORE FUNCTIONS

1. 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. Assists all functional areas with ensuring they’re aware of current deliverables, are on track to meet deliverables and assist with resolution for any challenges or items by raising concerns to appropriate payer contacts or internal leadership.

2. Reviews and analyzes reports of various activities to determine payer product progress toward stated goals and objectives, which includes designing, monitoring and improving the processes that support value-based care.

3. 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, focusing on contracts that meet the Learning Action Network Model (LAN) categories 3 with downside risk and 4 with capitation. This includes but is not limited to assuring interfaces with payers in delivering population and medical management activities and tools such as case management, , operationalizing strategies and initiatives around provider networks, IT, analytics, contract performance, finance and any compliance/legal requirements.

4. 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.

5. 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.

6. Participates as member of Strategy development for assigned payer. Establishes communication, training and orientation tools for BH leaders related to ACO and payer projects.

7. Participate as member of negotiation team for assigned payer where required.

8. This position has responsibility for BHN, BNC and BNSA activities that involve projects throughout the organization. Customers include leaders in the BHN, BH, hospital staff, physicians, payers, subcontracted network providers and consultants. This position is responsible for projects across multiple departments system-wide and requires interaction at all levels of staff and management. Requires work in context of multiple commitments, priorities and conflicts.

MINIMUM QUALIFICATIONS

Requires knowledge as typically obtained through the completion of a Bachelors degree in Business or Healthcare and seven plus 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.

Value-based contracting experience with the ability to validate data directly tied to population health and value-based care.

Ability to work independently while managing multiple projects in rapidly changing environment.

Demonstrated successful management of payer contracts containing downside risk or full capitation.

PREFERRED QUALIFICATIONS

Project Management experience preferred.

Ability to quickly organize and influence teams to execute and deliver results.

Additional related education and/or experience preferred.

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EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)

Our organization supports a drug-free work environment.

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EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability