Department Name:
QualityWork Shift:
DayJob Category:
Risk, Quality and SafetyEstimated Pay Range:
$40.91 - $68.19 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.A network with resources for leaders with vision. Our leaders are at the front of the health care transformation, planning the future of Banner Health. If changing health care for the better sounds like something you want to be part of, we want to hear from you.
The Senior Manager, Quality of Care is responsible for leading and overseeing the health plan’s Quality of Care program. In this role, you will manage clinical case reviews, peer review processes, and quality-of-care investigations related to member complaints, adverse events, and potential sentinel events. You will ensure compliance with Medicaid, CMS, state, and accreditation requirements, while directing root cause analyses and driving sustainable corrective and preventive actions.
You will partner with Medical Directors, Compliance, Provider Relations, and Operations to implement provider quality interventions and resolve systemic care issues. Additionally, you will develop, optimize, and standardize operational workflows and policies to ensure audit readiness and timely resolution. This role also involves analyzing quality trends to identify risks and opportunities for improvement, as well as leading, coaching, and developing staff. Finally, you will drive continuous process improvement initiatives to strengthen quality outcomes, regulatory performance, and member safety.
This position is remote for candidates residing in Arizona. The shift is Monday-Friday, 8:00am-5:00pm.
Banner Plans & Networks (BPN) 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 BPN, 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 provides managerial support to Quality Management team and assists in providing effective operations and improvement of quality management services, including hospital-wide performance improvement, regulatory compliance, individual case analysis and follow-up including sentinel events, and decision support. All work processed by the incumbent is considered confidential and protected from discovery, pursuant to state statutes.
CORE FUNCTIONS
1. Assists in assuring the provision of accurate and reliable data acquisition and analysis to support clinical and administrative decision-making.
2. Manages significant clinical event process, including identification, investigation, and coordination of root cause analysis, process improvement, tracking, and reporting.
3. Assists in the coordination of activities to assure compliance with accreditation and regulatory requirements (e.g. JCAHO, DHS, HCFA).
4. Participates in the hiring, training and conducting of performance evaluations and directs the workflow for the department staff. Provides leadership assistance to Quality Management staff to achieve optimal clinical, operational, patient safety, financial and satisfaction outcomes. Serves as a primary resource to staff and administration in the absence of the director.
5. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
6. Participates in the development and implementation of Quality Mgmt Services goals and objectives and process improvements. Ensures all goals and objectives are met timely and effectively.
7. Facility-based with budgetary responsibility. Internal customers: all levels of nursing management and staff, medical staff, and all other members of the interdisciplinary healthcare team. Internal customers: Care Management and Organizational Performance Division and associated work groups and teams. External customers: physicians, payers, community agencies, provider networks and regulatory agencies.
MINIMUM QUALIFICATIONS
Must possess the knowledge typically gained from the completion of a Bachelor's degree in appropriate healthcare-related field or the equivalent training and experience.
For positions in Hospital Operations: Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources. For positions in Medicaid or Insurance Division: Must have working knowledge of Quality Management processes including audits and performance improvement plans and root analysis.
Requires excellent leadership skills and an ability to interact well across departments, facilities, and organizations. Excellent organizational, human relations and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. A working knowledge of the medical staff organization, risk management, regulatory programs, and data management and analysis is required.
PREFERRED QUALIFICATIONS
Master’s degree and Certified Professional in Healthcare Quality (CPHQ) certification preferred.
Additional related education and/or experience preferred.
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