Sr. Director, Medicaid Quality Management

Primary City/State:

Arizona, Arizona

Department Name:

Clinical Decision Making

Work Shift:

Day

Job Category:

General Operations

At Banner Health, we set leaders up to succeed. We ensure leaders have the staff and resources their vision requires. Join a nationally recognized leader that values excellence and begin making a difference in people’s lives. 

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 will be a key member of our executive team, responsible for leading and directing our quality management initiatives, including but not limited to quality management performance improvement, quality of care, and quality related audits. The position will oversee the development, implementation, and evaluation of quality improvement strategies to ensure the highest standards of care for our Medicaid members. This role requires a dynamic leader who works well as a member of a team and engages all departments as critical contributors to overall quality.  In addition, this role requires a deep expertise in evidence-based practices and strategies for healthcare quality including understanding of quality metrics,  regulatory requirements, and Medicaid managed care systems.

CORE FUNCTIONS

1. Serves as the primary advisor to the organization’s senior management; Leads leaders.

2. Sets the department budget to meet organization goals and objectives and has full budgetary accountability.

3. Sets the organizational policies, procedures, and practices. Sets 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. Sets strategic direction and drives execution for functional area(s).

MINIMUM QUALIFICATIONS

Bachelor’s degree in healthcare administration, public health, nursing, or a related field.

Significant technical and managerial, typically gained through 10+ years relevant experience.

Deep expertise in evidence-based practices and strategies for healthcare quality including quality measurement, improvement and quality of care methodologies, and regulatory requirements specific to Medicaid managed care. Familiarity with Arizona's Medicaid programs and healthcare landscape is an advantage.

PREFERRED QUALIFICATIONS

Relevant certifications (e.g., Certified Professional in Healthcare Quality (CPHQ)) are highly desirable.

Located in Arizona, and an Arizona-licensed RN, physician, physician assistant in good standing or CPHQ certification through the National Association for Health Care Quality (NAHQ)

Comparable education and experience in health plan data and outcome measures.

Advanced leadership experience with quality management and clinical investigations

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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