**Primary City/State:** Phoenix, Arizona **Department Name:** Clinical Decision Making **Work Shift:** Day **Job Category:** Physicians 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 leads and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid, and commercial lines of business. This includes our wholly owned health plans (MA, DSNP, Commercial, Medicaid), and our fully delegated arrangements when our Clinically Integrated Networks (CINs) take downside risk. This leader, as part of Banner’s Population Health Services Organization (PHSO), will serve as the clinical DYAD to the Executive Director of Risk Adjustment, co-leading a robust team that will support the plan and CIN leaders in our markets, which include (but are not limited too) Arizona and Colorado Front Range. CORE FUNCTIONS 1. Creation, refinement, and implementation of robust provider education programs supporting HCC, HHS, and CDPS+Rx. Can include webinars, on-site sessions, at the elbow provider/clinic discussions, and other methods to support adult learning. 2. Oversight of the clinical query and suspecting programs and logic, including evaluation of how well our provider groups, coders, and clinical decision support tools are supporting accurate documentation of illness burden. 3. Establish clinical education standards for our coding and PCR staff and ensure our internal and external vendors (IHA teams) are meeting a high standard of performance. 4. Key decision maker with IT/Informatics/PHSO leaders in selection of vendors to support this work (IT solutions, IHA groups, EMR decision support, analytics). 5. Development of dashboards with key business stakeholders to help them understand process metrics and KPIs and assist in action plan development. 6. Oversee chart audit efforts of PHSO staff including but not limited to, inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims. 7. Maintains thorough and current knowledge of clinical care and treatment of assigned patient populations to critically assess appropriateness of documentation, including inpatient care opportunities at Banner acute care hospitals. 8. Provides insights to internal and external team members regarding the clinical impact that inadequate or inaccurate coding has on our ability to render appropriate quality of care for members. 9. Lead and develop risk adjustment strategies in parts of the Banner Health delivery system that are newly exposed to managing risk in populations, including urgent care, emergency departments, hospitals, home health, specialty medical groups, etc. MINIMUM QUALIFICATIONS Medical Doctorate or Doctor of Osteopathy Degree required with appropriate Board Certification or qualification of clinical practice experience. Must possess a strong knowledge and understanding of managed care operations, reimbursement models, medical protocols and criteria including Medicare criteria, and peer review statutes as normally obtained through seven years of medical practice experience, including two years management level experience within a healthcare system setting or large multi-operational, complex corporate environment. Must possess a current knowledge of clinical protocols, reimbursement challenges, and managed care principles. Must possess excellent oral, written, and interpersonal communication skills to effectively interact with all levels within the organization, as well as outside parties. Experience with hospital organized medical staff, managed care organizations, and continuous quality improvement activities. Proven experience and track record of predicting the futuristic relevancy and applicability of innovative industry trends, both technological and programmatic. Proven track record leading physician groups, including group facilitation, leadership development, team building, performance management, and driving cultural change. Experience working with physicians to strategize and develop measurable improvements the quality of clinical care and patient satisfaction. Proven experience implementing a continuous improvement culture. Experience implementing and maintaining a patient-centered, healing culture. Proven track record of partnering with medical staff to achieve desired facility-specific and organizational outcomes. Knowledge of modern national trends in hospital technology, quality, and patient safety. Knowledge of health care reform, population health management, and ACO trends and developments. Skilled in effectively handling multiple conflicting assignments, demands, and priorities with great attention to detail; coaching and developing direct reports and/or other employees by providing open and honest feedback that results in enhanced performance outcomes; establishing, pursuing, and monitoring appropriate process and outcome measures for key initiatives utilizing a systems perspective; evaluating the processes by which clinical care and patient services are delivered, identifying areas for of opportunity, setting standards for outcomes, developing appropriate systems to monitor outcomes, and overseeing the implementation of process improvements; quickly assessing and assimilating industry trends in order to act quickly and appropriately to changing environmental factors; influencing others and translating strategies into actions; motivating physicians and building teams; influencing physician behaviors; partnering and problem solving with physicians and hospital and practice management leaders. 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; and passionate about continuously improving and providing high quality care and service excellence to patients, families, employees and physicians. PREFERRED QUALIFICATIONS Family Medicine or internal Medicine 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