The Banner Health Insurance Division has an exciting new opportunity to join the growing team of Physician leaders in a non-clinical leadership role at Banner Health Corporate Center in Phoenix, AZ. Regarded and recognized as a top health system in the country for the clinical quality consistently provided to patients in our hospitals, Banner Health operates 30 hospitals, including three academic medical centers and other related health entities and services in six states: Arizona, California, Colorado, Nebraska, Nevada, and Wyoming.

The Banner Health Insurance Division manages over 1 million members in value-based contracts, including ACO models, down-side MA contracts (both full and partial delegation), a joint venture commercial plan called Banner|Aetna, and a fully owned Medicaid Plan. Members in these plans live across Arizona and Northern Colorado, and are managed by providers in many of Banner’s clinically integrated networks (CIN) and contracted providers. The Insurance Division has a Population Health Services Organization (PHSO) that provides services for both our owned health and affiliated health plans.

The Banner Health Insurance Division Medicare Advantage Clinical Officer will have responsibilities for developing the clinical programs, care models, and strategies for improved clinical outcomes for our wholly-owned Medicare Advantage (MA) Plans (Banner Medicare Adv. PPO, HMO, and Duals). This leader will have matrixed reporting relationships between our Medicaid and commercial Medicare leadership teams, and will leverage the resources within our Population Health Services Organization (PHSO) to most effectively perform in areas such as (but not limited to) STARs/HEDIS performance, quality concerns, care management, utilization management, coding accuracy, and Banner delivery integration. In partnership with our MA plan executive teams, this individual will assist in promoting the product and building relationships in the clinical and broker community for successful annual enrollment and ongoing member growth.

This leader will also assist in developing specialty-specific strategies with our CIN Medical Directors for the specialties most impactful in reducing avoidable health care spending for our senior members, which could include leading the development of guidelines and practice standards with community physician leaders and other clinicians to ensure success in our value-based payer arrangements. A strong understanding of the value-based payer landscape is preferred, as well as an understanding of clinical/operational levers needed to optimize outcomes for MA members in various care settings: ambulatory clinics, acute care facilities, ancillary facilities, etc.

Qualifications and Essential functions include:

• Experienced Board-Certified Physician, minimum of 5 years of practice experience
• Health plan experience required
• Medicare Advantage experience is a plus
• Schedule M-F | 8-5 PM
• Oversee the medical direction/administration of designated care management programs within the Plans and clinically integrated network. Promotes concepts and practice of quality improvement. Establishes and maintains effective working relationships with physician and provider stakeholders. Assist in the development of operational policies, procedures, criteria, and/or guidelines, which impact the delivery of quality medical care. Direct the development and implementation of protocols or guidelines.
• Works within the appropriate leadership model to establish, monitor, and improve aggregate clinical outcomes. Actively participates in or leads care management activities to improve patient safety, provide patient-centered, appropriate and timely care, reduce inappropriate variation, implement evidence-based standards, enhance efficiency and throughput, and evaluate innovative clinical methods and opportunities. Works with other leaders to assess and improve the professional practice of independent, contracted, and employed medical providers.
• Oversees the quality assessment and improvement activities, including outcome measurements, preventive services, quality and accessibility of services, and peer review as directed. Implements quality standards for the Health Plan and providers, and oversees the development of statistical data to measure performance against quality standards.
• Provides leadership, supervision, guidance, and development for staff, articulating and demonstrating an expectation for continuous quality improvement, as well as continually supporting and exhibiting company values and service standards. Identifies and provides growth opportunities for staff. Participates in the review of qualifications, credentials, performance, professional competence, and character of physician and provider stakeholders. May participate in the medical staff professional review process and physician recruitment.
• Ensures and fosters a high level of collaboration within a highly matrixed team environment in order to coordinate activities, review work, exchange information, and resolve problems. Champions, models, and promotes service excellence philosophies and behaviors to enhance the overall patient experience.
• 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.
• Improve the quality and appropriateness of care for Banner Health’s Clinically Integrated Networks and Banner Plan Administration (BPA) and provides guidance for clinical operational aspects of Utilization Management. This position is responsible for the oversight of clinical decision-making aspects of the program and ensures qualified clinicians are accountable to BPA for decisions affecting customers. This position has authority and responsibility for the quality management program and serves on the Quality Management Committee.  Serves as Liaison among facility leadership, external organizations, and contracted payer organizations. This position interacts frequently with hospital leadership and medical staff, physicians and physician practice staff, as well as regulatory agencies, and the community. 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.

Banner Health’s Total Compensation package includes:

• Competitive salary
• Paid malpractice
• Paid CME
• 401k retirement plan with 4% match after one year of service
• Excellent benefit package options that provide security for you and your family

We encourage you to submit your CV to doctors@bannerhealth.com For questions, please call Tiffany Lewis, Sourcing Director, at (602) 747-4578. Visit our website:  www.bannerhealth.com Please, No Agency Solicitation.

The safety of our team members and patients is of utmost importance, so Banner is requiring the COVID-19 vaccine for all team members. As members of the health care field, we are in the business of caring for people, so we take seriously our commitment to ensure our patients and teams are safeguarded from this rapidly changing and dangerous disease.

As an equal opportunity and affirmative action employer, Banner Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences and backgrounds. Banner Health is an EEO/AA - M/W/D/V Employer.