RN Population Health

Department Name:

AZ Pop Health-Clinic

Work Shift:

Day

Job Category:

Nursing

Health care is changing, and it’s our goal to create a new model to answer America's health care challenges today and in the future. Our passionate and talented teams will be the change on the health care landscape in our communities big and small. This is the perfect opportunity for a Registered Nurse with experience in population health strategies including quality, value based measures, and/or risk adjustment.

The Registered Nurse should have experience in developing collaborative relationships with physicians/APPs, strong communication skills, and be comfortable presenting information within a group setting. In this role you will have the opportunity to work alongside Medical Group Executive leadership while developing relationships with all Banner employees in a true collaborative integrated team model. 

Your focus in this role will be workflows and operations and you would be responsible for multiple geographic areas in the west valley. You would have true collaboration amongst service line partners and high visibility with senior executives.  

At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.

POSITION SUMMARY
This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization’s Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.) This includes collaborating with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs).

CORE FUNCTIONS
1. Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group. Coordinates the business design, testing and implementation of web-based RAF tools and reports in areas of expertise. Monitors and ensures tools are available post implementation. Responsible for the development and implementation of Risk Adjustment education and training for network physicians and practices, including documentation and coding requirements, HCCs, HEDIS quality ratings.

2. Establishes and promotes a collaborative relationship with physicians, third party vendors, and other members of the health care team. Collects and communicates pertinent, timely clinical information to third party vendors and others to fulfill utilization and regulatory requirements.

3. Assess accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately, with a goal to optimize the program’s financial benefit to Banner Health.

4. Partners with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools. Provides formal training and supports physicians and practices in the day to day utilization of Risk Adjustment tools throughout Banner Medical Group.

5. Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools. Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution. Develops and implements recommendations to improve business processes to support and/or optimize RAF scores. Works collaboratively with ambulatory care management to ensure quality performance criteria expectations are disseminated so physicians and practices are equipped to meet and/or exceed clinical targets.

6. Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities. Meets regularly with BMG workforce team to review findings and develop an improvement plan to meet organizational goals. Partners with Risk Adjustment Quality Analysts and Educators to develop educational materials. Meets regularly with workforce teams to support communication and promote partnership.

7. Participates in or leads Risk Adjustment projects designed to improve program