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Banner Health Health Plan Quality of Care Master Social Worker in Phoenix, Arizona

Primary City/State:

Phoenix, Arizona

Department Name:

IPA Mgmt

Work Shift:

Day

Job Category:

General Operations and Culinary Services

At Banner Health, we believe that “leadership matters” and is a key component to providing excellent patient care. Join a nationally recognized leader that values excellence, and begin making a difference in people’s lives.

As a Health Plan Quality of Care Master Social Worker you will support our Banner Health Plans. Banner Health Complete Care- a plan that will be focused on the integration of physical health and behavioral health. We are known nationally as an innovative leader in new health care models, where insurance plans and physicians come together to work collaboratively to make things easier for the member. The division serves over 500,000 members in our community.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

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 coordinates the investigation of quality of care concerns for Banner University Health Plan members that have been referred to the Quality Management Department for review and resolution.

CORE FUNCTIONS

  1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, preparation of acknowledgment and closure correspondence, tracking cases in database.

  2. Prepares Quality of Care cases and presents cases to Medical Director for review.

  3. Assists in the development and implementation of the Organization wide Banner University Health Plan Quality of Care training program.

  4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, QM Director and QOC Supervisor.

  5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate staff.

  6. This position makes decisions that facilitate smooth coordination of care to ensure member’s care needs are met while maintaining quality standards in a financially responsible manner. Performs independently.

MINIMUM QUALIFICATIONS

Two years of clinical experience in an acute care or outpatient setting; at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required.

Requires a Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW); a Licensed Professional Counselor (LPC) or Licensed Associate Counselor (LAC), a Licensed Marriage and Family Therapist (LMFT) or an Licensed Associate Marriage and Family Therapist (LAMFT), a Licensed Independent Substance Abuse Counselor (LISAC) or a Licensed Associate Substance Abuse Counselor (LASAC). An equivalent license applies to states that do not recognize an LCSW or others as specified; therefore, the employee must possess a Master’s Degree and be a Licensed Social Worker, Counselor, Marriage and Family Therapist or Substance Abuse Counselor.

Knowledge of National Medicare and State AHCCCS regulations is required. Excellent written and verbal communication skills, strong analytical, problem solving, concurrent and retrospective data management and computer skills are necessary.

The ability to identify variances from protocol and the ability to work independently to identify, develop, monitor, evaluate, report and perform ongoing, objective, cyclic, and systematic QI indicator data, and the ability to establish good working relationships with all levels of BUHP support staff, providers, administrative staff and all other internal and external customers.

PREFERRED QUALIFICATIONS

A CPHQ is preferred.

Additional related education and/or experience preferred.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

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