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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.
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.
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.
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.
A CPHQ is preferred.
Additional related education and/or experience preferred.
Internal Number: R25600
About Banner Health
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.