Senior Medical Director, Network Performance
Apply NowCompany: Banner Health
Location: Phoenix, AZ 85032
Description:
Primary City/State:
Phoenix, Arizona
Department Name:
Clinical Decision Making
Work Shift:
Day
Job Category:
Physicians
The Senior Medical Director, Network Performance is a senior clinical executive responsible for advancing the performance of Banner Health's network of employed and contracted providers across Medicare Advantage, Medicaid, Commercial, and government value-based programs. This role leads enterprise strategies to improve cost efficiency, quality outcomes, risk adjustment accuracy, and contract performance across lines of business along with other leaders in Banner Health Population Health Services Organization (PHSO).
Our ideal candidate will be a skilled and trusted change agent, with a demonstrated track record of leading providers through complex transformation efforts in care delivery, documentation, and performance accountability. Through data-informed leadership, enterprise collaboration, and credible clinical engagement, the Senior Medical Director will ensure Banner's network strategy consistently delivers measurable value for patients, providers, and the organization.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.
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 in the Insurance Division, is responsible for providing leadership to Medical Directors, administrators, and providers within healthcare delivery to help accomplish organizational goals tied to the Quadruple Aim. These leaders are valuable members of the Banner Insurance Division team and will represent Banner Health both in internal and external forums. This position regularly interfaces with market health insurance payers and provider entities.
Areas of responsibility could include but are not limited to:
Utilization management: Leading teams and partnering with Senior leaders to ensure appropriate levels of health care utilization are met for our wholly owned and delegated plans in the areas of prior authorization, census management, prospective/concurrent/retro review, and appeals.
Care management: Coordinating/reviewing the work of RNs, navigators, social workers, and other clinical support staff to create excellent member outcomes and reduce unnecessary utilization
Clinically Integrated Network: Supporting providers in our various markets through appropriate forums creating engagement, clinical transformation, improvements in network performance, and integrating these touch points with greater Banner Health Delivery. Interface with our payers in Joint Operations Councils and related operational meetings to exceed performance targets in our value-based contracts.
Insurance Clinical Operations: Ensure appropriate clinical outcomes are achieved and overseeing Quality of Care work for our health plans. Creation of the model of care and setting the clinical goals/vision for the plan and adhering to all guidelines and regulations set by local/state/national entities.
Innovation and Clinical Redesign: Leveraging non-traditional methods and emerging technologies to achieve quadruple aim goals, and partnering with Division leaders to successfully operationalize these.
CORE FUNCTIONS
1. Directs, supervises, and evaluates the work of direct staff and matrixed employees.
2. Participates into the development of the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.
3. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.
4. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.
MINIMUM QUALIFICATIONS
Medical Doctorate or Doctor of Osteopathy Degree required with appropriate Board Certification or qualification of clinical practice experience.
Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver's 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.
Significant technical and managerial experience, typically gained through five plus years relevant experience.
PREFERRED QUALIFICATIONS
At least three years working either within health plan operations, a clinically integrated network, a vendor in the population health space, an integrated medical group with deep experience in value-based medicine, or a leadership position within an integrated healthcare delivery system.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Phoenix, Arizona
Department Name:
Clinical Decision Making
Work Shift:
Day
Job Category:
Physicians
The Senior Medical Director, Network Performance is a senior clinical executive responsible for advancing the performance of Banner Health's network of employed and contracted providers across Medicare Advantage, Medicaid, Commercial, and government value-based programs. This role leads enterprise strategies to improve cost efficiency, quality outcomes, risk adjustment accuracy, and contract performance across lines of business along with other leaders in Banner Health Population Health Services Organization (PHSO).
Our ideal candidate will be a skilled and trusted change agent, with a demonstrated track record of leading providers through complex transformation efforts in care delivery, documentation, and performance accountability. Through data-informed leadership, enterprise collaboration, and credible clinical engagement, the Senior Medical Director will ensure Banner's network strategy consistently delivers measurable value for patients, providers, and the organization.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.
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 in the Insurance Division, is responsible for providing leadership to Medical Directors, administrators, and providers within healthcare delivery to help accomplish organizational goals tied to the Quadruple Aim. These leaders are valuable members of the Banner Insurance Division team and will represent Banner Health both in internal and external forums. This position regularly interfaces with market health insurance payers and provider entities.
Areas of responsibility could include but are not limited to:
Utilization management: Leading teams and partnering with Senior leaders to ensure appropriate levels of health care utilization are met for our wholly owned and delegated plans in the areas of prior authorization, census management, prospective/concurrent/retro review, and appeals.
Care management: Coordinating/reviewing the work of RNs, navigators, social workers, and other clinical support staff to create excellent member outcomes and reduce unnecessary utilization
Clinically Integrated Network: Supporting providers in our various markets through appropriate forums creating engagement, clinical transformation, improvements in network performance, and integrating these touch points with greater Banner Health Delivery. Interface with our payers in Joint Operations Councils and related operational meetings to exceed performance targets in our value-based contracts.
Insurance Clinical Operations: Ensure appropriate clinical outcomes are achieved and overseeing Quality of Care work for our health plans. Creation of the model of care and setting the clinical goals/vision for the plan and adhering to all guidelines and regulations set by local/state/national entities.
Innovation and Clinical Redesign: Leveraging non-traditional methods and emerging technologies to achieve quadruple aim goals, and partnering with Division leaders to successfully operationalize these.
CORE FUNCTIONS
1. Directs, supervises, and evaluates the work of direct staff and matrixed employees.
2. Participates into the development of the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.
3. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.
4. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.
MINIMUM QUALIFICATIONS
Medical Doctorate or Doctor of Osteopathy Degree required with appropriate Board Certification or qualification of clinical practice experience.
Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver's 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.
Significant technical and managerial experience, typically gained through five plus years relevant experience.
PREFERRED QUALIFICATIONS
At least three years working either within health plan operations, a clinically integrated network, a vendor in the population health space, an integrated medical group with deep experience in value-based medicine, or a leadership position within an integrated healthcare delivery system.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy