Senior Director, Chief Value Performance Officer, Population Health Services Organziation
Location: Phoenix, Arizona
Type: Full Time
Internal Number: R60145
PHSO Admin Dept
General Operations and Culinary Services
Banner Health believes leadership matters. We look for leaders who share our vision of making health care easier, so life can be better. We value, and celebrate equity, diversity and inclusion and our leaders are at the forefront of the health care transformation, planning the future of Banner Health.
In the highly visible role of Senior Director, Chief Value Performance Officer, Population Health Services Organization, you will oversee the delivery of Insurance Division Transformation programs. You will be responsible for directing and administering the Banner Health Insurance Division Transformation programs and processes, with focus on clinical transformation, regulatory compliance and providing superior service across the enterprise. You will be an experienced leader with a proven track record in execution and influence at the highest level, as we continue to transform as an organization in innovation.
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.
This position monitors and oversees the delivery of Insurance Division Transformation programs for Banner Health. This position is responsible for directing and administering the Banner Health Insurance Division Transformation programs and processes, with focus on clinical transformation, regulatory compliance and providing superior service across the enterprise. The Insurance Division Transformation Unit works to support the financial goals and objectives as developed by the Board of Directors and senior executive management. This position is responsible for serving as a role model to staff across the system and representing Banner in a positive manner both within and outside the organization supporting transparent collaborative stakeholder relations. Expectations are to Promote a collaborative, open, and inclusive work environment within a highly matrixed organization. This position serves as the primary advisor to the organization's senior management on matters related to tools and operational programs to ensure sustained high quality performance outcomes and risk adjustment factor accuracy. Directs operations of the Administrative Services Organization (ASO) Transformation departments including Provider Practice Transformation, Quality Performance, Continuous Quality Improvement, Quality Outcome Reporting, Provider Scorecard Analysis, Coding Education, Member Experience, and specialty performance network design.
CORE FUNCTIONS 1. Guides the development and implementation of short and long-range goals and objectives for the Insurance Division's transformation operations; assuring efficient and effective use of people, services and technology ultimately impacting positive quality performance and financial outcomes. Incorporates best practices and responds to emerging trends to enhance operations, programs, and/or services. This includes developing and implementing strategies that supply network provider's with actionable information on a recurrent basis to drive improved quality performance and risk adjustment factor accuracy, focusing on population health improvement.
2. Works in collaboration with the Chief Medical Officer and ASO senior leadership team to direct the Insurance Division's transformation operations to achieve and sustain high-performing quality outcome performance (e.g., Medicare Stars measures or other similar metrics), and to optimize risk adjustment accuracy. Accountable for achieving plans and performance targets. This includes leading the development of new and innovative programs that will achieve positive results in alignment to Insurance Division, BUHP, BNC and BHN requirements, as well as alignment, as appropriate, to Banner Health entities impacted by ASO services.
3. Serves as a strategic visionary partner with the ASO senior leadership team driving and facilitating enhanced position of all products and plans in all markets and with all partners. Serves as primary advisor to the organization's senior management on matters related to deployments of current and future quality and risk adjustment technologies. Closely partner with Banner IT to identify new technologies that will improve workflows related to quality performance or risk adjustment accuracy.
4. Oversees performance of all Transformation Unit's Departments, with an emphasis on ensuring meaningful provider engagement, while ensuring compliance with all regulatory requirements, contractual requirements. Directs day-to-day operations and high-performing staff to optimize available resources for a high performing and efficient Transformation Unit. Holds staff, managers and directors accountable for achieving plans and performance targets. Works with cross-functional team members to identify and resolve the most complex issues and problems impacting specialty clinical performance assessment and improvement programs.
5. Provides executive sponsorship and oversight in the development of operational policies, procedures and/or guidelines, which impact on quality performance. Directs the operationalizing of policy, protocols or guidelines in compliance with AHCCCS, Arizona Administrative Code, AZ Department of Insurance, and CMS regulations as well as delegating payer requirements.
6. Develops and oversees 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. Manages and reports expenditures and accounts payable transactions.
7. Works to identify areas amenable to optimizing use of Insurance Division Funds by directing ongoing analysis and evaluation of quality performance outcomes and business planning necessary to drive sustained high quality outcome performance to ensure continued growth. Uses forecasting and advanced data modeling techniques to proactively identify improvement opportunities and program development. Participates as a subject-matter expert and may lead or facilitate task forces, teams, and/or councils to plan, implement and coordinate programs, services, and/or activities for the organization. May serve as a staff resource to the organization's Governing Board and/or applicable committees.
8. This highly complex role has direct leadership accountability for the quality performance of the Insurance Division with aligned providers, partners and vendors. Requires interactions with all levels of staff, management and physicians. This position requires the skill to negotiate and influence. Actions initiated by this position must be consistent with policies and procedures developed by the organization's insurance plan division, the provider relations department and the organization's network of physicians and hospitals. This position requires the skill to negotiate and influence. Customers of this position are both internal and external, including leadership, staff, medical staff, regulatory agencies, and/or the community.
Expert-level working knowledge of principles, practices, and operations as normally obtained through the completion of a master's degree business, healthcare or related field coupled with five or more years of increasingly responsible administrative leadership experience in an integrated administrative services environment or large multi-operational, complex environment.
Seven years of director level experience in healthcare management, with at least five years of experience in either managed care, commercial insurance, accountable care organization or delivery system operations is required. Must have knowledge of operational quality improvement processes. Must have knowledge of the requirements of national/state accrediting agencies, such as NCQA, HEDIS, Medicare (CMS) and Medicaid (AHCCCS). Experience in Medicare and Medicaid managed care clinical and quality management is required. Must be able to demonstrate successful experience and program development/improvement in ACO operations. Experience in Medicare/AHCCCS Compliance programs is desirable. Proven track record of partnering with providers, community and organizational leaders to achieve desired organizational outcomes. Proven experience in leading fiscally sound, profitable, efficient, and responsible healthcare operations. Strong financial and business acumen, including a keen understanding of operational and financial measures that define success, as well as budgeting and forecasting methodologies, including working knowledge of capital planning and capital investment practices. Knowledge of emerging trends in quality and member safety. Skilled in coaching and developing direct reports and/or other employees that results in enhanced performance outcomes; setting and pursuing aggressive priorities and goals that demonstrate a strong commitment to overall organizational success; effectively allocating resources in order to accomplish goals and objectives; assessing and assimilating facility and industry financial dynamics in order to act quickly and appropriately to changing environmental factors; negotiating win-win scenarios with outside vendors/partners while representing the Insurance Division products, partners, and organization in the best possible light; developing collaborative and positive relationships with providers, regulators, employees, volunteers, the community, and/or other applicable parties; measuring and managing work outputs. Excellent human relations, organizational and communication skills are essential. Leadership style and characteristics necessary to effectively perform in this role include: strong work ethic; results-oriented; persuasive; motivational; able to make rational decisions in difficult situations; inspirational; honorable; confident; systems-thinker; innovative; life-long learner; courageous; high-energy; integrity; collaborator; ability to work with teams; good listening; nonvolatile; values multiple disciplines; community visibility and leadership; and passionate about continuously improving and providing high quality care and service excellence to members, families, employees and providers.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
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 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.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.