**Primary City/State:** Phoenix, Arizona **Department Name:** Health Mgmt **Work Shift:** Day **Job Category:** Clinical Care A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. If you’re looking to leverage your abilities – you belong at Banner. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. As a Health Partner, you will be working with the Arizona Health Care Cost Containment Services (AHCCCS) adult population. You will be working with an RN to manage members in their home setting. This member population does have a variety of social determinants of health that you, the Health Partner, will help them to overcome. You will help members reduce utilization, help members coordinate care, and ultimately be able to self-manage their chronic conditions in order to remain safe in their home. You will be receiving new referrals every day and secondary referrals from RNs. You will then outreach to the member to enroll. The team is NCQA accredited, so there is a comprehensive assessment that needs to be completed for every member enrolled in our program. Members are in our program for 60-90 days (on average). This is a remote hybrid role. **Phoenix, Arizona metro area residency is required for this role.** You will be working in a remote home office, doing visits in members' homes and eVisits, and at the Banner Corporate Center Mesa. Your work schedule will primarily be Monday-Friday 8:30 a.m.-5:00 p.m. in the Arizona Time Zone. This is a salaried and exempt from overtime position. If this role sounds like the one for you, apply today! 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 responsible to manage members with high risk, chronic complex conditions, rising risk, and acute conditions in the delegated populations. The Health Partner will be the main point of contact for members and providers across care settings. The aim is to better manage members in a home-based setting providing a variety of support functions which contribute to the overall improvement in members’ healthcare quality of life as well as efficient use of resources. Engages the appropriate resources within the multidisciplinary team to achieve optimal results for the member, family, and care givers. This position provides comprehensive care coordination for members as assigned. This position ensures adherence to the plan of care and develops, implements, monitors, and documents the utilization of resources and progress of the member through their care, facilitating options and services to meet the members’ health care needs. CORE FUNCTIONS 1. Manages individual patients across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Coaches members regularly regarding disease related symptom management. Advises members on lifestyle choices to improve prognosis and overall health. Provides patient monitoring, education, and supports patient care plan adherence. 2. Provides self-management support. Including, but not limited to; using checklists and escalating as prescribed by protocols, promoting healthy behaviors, imparting problem-solving skills, and assisting with the emotional impact of chronic illness, providing regular follow up and encouraging members to be active participants in their care. 3. Applies the skills of motivational interviewing to promote the above lifestyle changes and member enrollment and participation in case management programs Provides emotional support by showing interest, inquiring about emotional issues, showing compassion, and teaching compassion. 4. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Bridges gaps between the member and the clinical team including but not limited to following up with members, asking about needs and obstacles, and addressing health literacy, cultural issues, and social-class barriers. 5. Meets and accompanies the member and family to their initial appointments and/or conducts in-home assessments based on members’ needs. Assists members in navigating the health care system by connecting resources, facilitating support, and empowering the member. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice. Interacts with all levels of staff in a variety of departments, physicians, payers, members, families, and external contacts, such as employees of other health care institutions, community providers, and agencies, concerning the health care and case management needs of the member. Interacts with other health care providers in numerous settings to report and ask for or clarify information. Synthesizes and prioritizes data from multiple sources to provide support for the human response of the member and family to changes in health status. 7. Contributes to society through activities that lead to excellent member outcomes through timely, effective, efficient, equitable, and safe care. Actively participates in the improvement of national social worker and case management quality indicators and outcomes. Such activities may include participating in professional organizations. 8. Provides assessment and interventions in scope of practice based on the best evidence available and may participate in research activities within clinical /case manager practice. Participates in unit or facility- based workgroups. Interacts and participates in the education, role development, and orientation of facility personnel, members, students, families, and visitors. Promotes/supports growth of others through precepting and mentoring when appropriate. 9. Completes assessment and reassessments according to member need and as outlined in policy and according to accreditation standards. Documents assessment, planning, implementation, and evaluation in the patient member record. Documentation is legible, timely, and in accordance with policy. Documentation reflects objective/subjective data, interventions, education, care coordination, and member's progress to plan of care. MINIMUM QUALIFICATIONS Requires a master’s degree in social work or related degree. Must possess knowledge of managing and coordinating care for members with chronic complex disease processes as normally obtained with two or more years of experience related to complex conditions in the acute care setting, behavioral health, and/or case management field. Requires a Licensed Master Social Worker (LMSW) (equivalent*) or Licensed Clinical Social Worker (LCSW) with two years of experience directly related to case management in health plan/management/quality. An equivalent license applies to states that do not recognize an LMSW, therefore, the employee must possess a master’s degree and be a Licensed Social Worker. BLS required for programs that are embedded in a clinical setting or conduct member community or home visits. Must have highly developed interpersonal and critical thinking skills with the ability to prioritize needs rapidly. This position requires the ability to convey messages and thoughts clearly to a diverse audience, using both verbal and written mediums. Requires the ability to promote change among members. Responsible, caring, and respect for all member populations, infants through geriatrics. Requires the ability to coordinate information and activities, work under stress of deadlines and frequent interruptions, and to possess analytical problem-solving skills. Must possess excellent organizational skills, as well as effective human relations and communication skills. Computer literacy and keyboarding skills is required. Must be proficient in the use of system office applications. Must possess a basic understanding of integrated clinical systems. PREFERRED QUALIFICATIONS Certification with nationally recognized healthcare organization, such as CCM, preferred. May require off-site travel with personal vehicle (i.e. Corporate locations or member face-to-face visits within their homes, physicians’ offices, and/or community resources). Provide own transportation, required to possess a valid driver’s license, and be eligible for coverage under the organization’s auto insurance policy. Additional related education and/or experience preferred. **EEO Statement:** EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo) Our organization supports a drug-free work environment. **Privacy Policy:** Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy) EOE/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. 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