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The Care Transformation team is responsible for assisting the contracted network to transform to value based care and population health. The team helps practices navigate the changes that are coming within the healthcare industry and interpret these changes to operational workflows at contracted offices.
As a Care Transformation Quality Improvement Specialist , you will work in a collaborative environment with both employed and network physicians in the transformation to value based care and population health management. This work will be accomplished through identifying areas of clinical performance improvement and implement strategies and tactics to assist with performance improvement. Becoming a member of our Care Transformation team you will be offered an opportunity for career advancement while working with a fun, energetic, and innovative team. Our leaders offer continuous learning and support. This position will work remotely.
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 plans, coordinates, implements and evaluates clinic quality/performance improvements, patient safety programs, and/or coordinates compliance and regulatory programs for preparedness and accreditation requirements. Reviews and audits medical records to ensure that the documentation justifies the data billed on encounters and supports performance indicators required in the system of care. This position uses established methodology in determining omissions, correctness errors and measures of timeliness for encounter submissions and performance indicators set by Arizona Department of Health Services (ADHS) and the Regional Behavioral Health Authority (RHBA). Provides verbal and technical assistance to staff in order to resolve identified errors.
CORE FUNCTIONS 1. Monitors and evaluates the overall quality of behavioral health services provided by Whole Health Clinic and its contracted service providers to ensure compliance with Regional Behavioral Health Authority (RHBA) contracts, state legislation, Arizona Health Care Cost Containment System (AHCCCS), and Arizona Department of Health Services (ADHS) and Division of Behavioral Health Services (DBHS) regulations.
2. Coordinates investigation, analysis, and responds to quality/patient safety issues, events, significant care issues or trends. Leads and/or facilitate root cause analysis, failure modes and effects analysis, and process improvement.
3. Develops and analyzes data for administrative and clinical decision making, as well as regulatory requirements. Coordinates implementation of data collection processes: provide analysis, summary, research and benchmarking. Prepares and present reports for appropriate facility, system, and other external agencies. Provides oversight to projects including data abstracting and data entry as appropriate.
4. Coordinates, prepares and assists with internal and external audits.
5. Investigates critical incidents and prepares reports of findings and provides recommendations for corrective action implementation.
6. Tracks, monitors and implements improvement actions and evaluates success.
7. Supports implementation of quality and patient safety goals, policies, procedures, and activities designed to meet the requirements of regulatory and accrediting agencies.
8. Completes all training required by licensing agency and funding source.
9. Has freedom to determine how best to accomplish functions within established procedures and best practices.The position will require communication and coordination with Banner Risk Management, ADHS, the RBHA, internal and external providers, courts, and other county, state, and governmental agencies. Responsibilities cross all levels of internal and external customers including but not limited to the medical staff, the community, regulatory bodies and state agencies.
Requires Bachelor's degree or equivalent in behavioral health, social services or other healthcare related field or equivalent experience.
Requires a proficiency level typically attained with two years of experience in behavioral health, case management, or quality management. Requires ability to perform complex statistical analysis and highly developed problem solving skills. Requires the ability to manage programs and projects. Requires demonstrated excellence in interpersonal and written communication skills.
Knowledge of CPT, ICD-10, HCPC and DSM coding. Employees working at the Whole Health Clinic must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
PREFERRED QUALIFICATIONS Knowledge of behavioral health case management principles and practices.
Additional related education and/or experience preferred.
Internal Number: R23419
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.