Registered Nurse RN Population Health Remote

About the position

Find your path in health care. Banner Health is committed to not only providing the finest care possible, but to advancing the way care is provided. To achieve our vision, we seek out professionals who embrace change and who possess the passion and skills to make it happen. Apply today. This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization's Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.) This includes collaborating with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs).

Responsibilities

• Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group.
• Coordinates the business design, testing and implementation of web-based RAF tools and reports in areas of expertise.
• Monitors and ensures tools are available post implementation.
• Responsible for the development and implementation of Risk Adjustment education and training for network physicians and practices.
• Establishes and promotes a collaborative relationship with physicians, third party vendors, and other members of the health care team.
• Collects and communicates pertinent, timely clinical information to third party vendors and others to fulfill utilization and regulatory requirements.
• Assesses accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately.
• Partners with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools.
• Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools.
• Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution.
• Develops and implements recommendations to improve business processes to support and/or optimize RAF scores.
• Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities.
• Participates in or leads Risk Adjustment projects designed to improve program offerings or address system limitations.
• Monitors data submission for attestation to CMS for Risk Adjustment.
• Analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance.

Requirements

• Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience.
• Must possess a current, valid RN license in the state of practice.
• Demonstrate effective relationship development skills, and ability to effectively communicate in individual and group settings.
• Requires critical thinking and project management capabilities.
• Position requires proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems.

Nice-to-haves

• Nursing experience in primary care, community nursing, critical care (ICU/ED) or utilization/prior authorization review.
• Knowledge/Experience with Risk Adjustment and Quality Measures (Stars, HEDIS).
• Proficient ability to use a computer and Microsoft Office.
• Familiarity with Cerner.

Benefits

• Flexible scheduling options.
• Opportunity to work remotely with occasional onsite requirements.
• Supportive work environment with a focus on community health.