Chief Health Services Officer Job at Banner Health in phoenix

Primary City/State: Phoenix, Arizona Department Name: PHSO Admin Dept Work Shift: Day Job Category: General Operations Position Summary This position directs the operations of the health services department of the Administrative Services Organization (ASO) including prior authorization, utilization management, program training and development, pharmacy technicians, care and case management, integrated care, behavioral health services and transplant coordination. The health services department is responsible for the day‑to‑day operations required to meet the standards governing the availability of services within the various plans according to AHCCCS, Arizona Administrative Code, AZ Department of Insurance, CMS Regulations and payer delegated duties to Banner Health. Core Functions Leads the strategy and direction of health services operations, assuring efficient and effective use of people, services and technology ultimately impacting positive financial and clinical outcomes. This includes developing and implementing strategies that support health services programs focusing on member care services, health improvement and quality outcomes. Strategic development, oversight and leadership of the Health Services Department, advancing the programs provided by Health Services to manage the membership of the Insurance Division programs and plans. Works with the Chief Medical Officer, medical directors and other medical management staff in making recommendations for operational changes to meet, maintain and improve operational efficiencies and to meet/exceed regulatory standards. Identifies areas amenable to optimizing use of Insurance Division funds. Collaborates with the CMO and the Medical Directors to develop and implement programs to achieve positive health outcomes while maintaining quality. Oversees the operational execution of all clinical care management programs within the ASO (Maternal Child Health, Behavioral Health, Care and Case Management, Pharmacy, Dental Services, Utilization Review, Concurrent Review and Transplant Coordination) in conjunction with Medical Directors. Collaborates with members of the ASO senior leadership team to direct health services operations to achieve cost containment and control within the limits of the standards and optimize available resources for a high‑performing efficient clinical administrative unit. Provides executive sponsorship and oversight in the development of operational policies, procedures and/or guidelines that impact the delivery of quality medical care. Directs operationalizing of medical policy, protocols or guidelines. Ensures compliance with state and federal regulation across all health service operational units, including access and provision of medical care. Accountability for ensuring the success of the organization, including setting strategic direction and providing strong, innovative, thoughtful and creative leadership in the achievement of strategic goals and objectives. Requires negotiation skill. Customers include internal and external leadership, staff, medical staff, regulatory agencies and the community. Minimum Qualifications Must possess strong management knowledge typically obtained through a master’s degree in business, healthcare or a related field, coupled with five or more years of increasingly responsible administrative leadership experience in a large, integrated administrative services environment or complex multi‑operational setting. Seven years of director‑level experience in healthcare management, with at least five years in managed care utilization, case or quality management, is required. Must have knowledge of clinical and operational quality improvement processes and accreditation requirements (NCQA, HEDIS, Medicare, Medicaid). Experience in Medicare and Medicaid managed care clinical and utilization management is required. Must demonstrate successful experience in program development/improvement in health plan clinical management. Experience in Medicare/AHCCCS compliance programs is desirable. Proven track record of partnering with providers, community and organizational leaders to achieve desired outcomes. Proven experience in leading fiscally sound, profitable, efficient and responsible healthcare operations. Strong financial and business acumen, budgeting and forecasting methodology, capital planning, emerging quality trends, coaching, and stakeholder relations skills. Excellent human relations, organizational and communication skills. Preferred Qualifications A current licensure as a registered nurse in the State of Arizona is preferred. EEO Statement EEO/Disabled/Veterans Privacy Policy Privacy Policy #J-18808-Ljbffr