**Primary City/State:**

Arizona, Arizona

**Department Name:**

Network Development

**Work Shift:**

Day

**Job Category:**

General Operations

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 is responsible for driving development and overall management of the provider network for the Banner Health Insurance Division, which may include but not limited to; Banner Health Network (BHN), Neighborhood Physician Alliance (NPA), Banner University Health Plans (BUHP), Banner High Value Networks, Medicare, Medicaid, and Commercial ACO’s and other products aligned to the Arizona market. This position is responsible for network development strategy, provider contracting, ongoing network management including value-based performance, regulatory monitoring of network adequacy and access; and provider relationships to align with Banner’s overall population health strategy.

CORE FUNCTIONS

1. Guides the development and implementation of short and long-range goals and objectives in support of the Insurance Division’s contracting and network management activities. This includes driving and overseeing strategic and tactical plans to align with Banner’s operational facilities and corporate areas.

2. Negotiates and oversees negotiation, implementation and management of provider contracts, participates in strategic planning, business development, service area expansion, and provider support services to ensure a competitive network is in place, and optimal terms and/or provisions are negotiated into assigned contracts and implemented as intended. Plays a key role in developing and monitoring financial and performance of the comprehensive provider network outcomes to assure attainment of organizational objectives. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Conducts ongoing financial analysis and implements performance improvement plans as needed to ensure optimal financial performance. Identifies changes in reimbursement methodologies and determines the financial impact to the various arrangements.

3. Ensures operational and financial goals are met by the Provider networks. Defines and leads high value network development and associated management strategies which includes value-based purchasing, collaborative care, center of excellence and ACO development and management.

4. Engages system, state, and regional stakeholders in ensuring and fostering a high level of collaboration to develop partnerships, oversee activities, review work, exchange information, and/or resolve problems. Promotes and models positive relationships across the organization.

5. Develops and manages provider and ancillary networks to support the AHCCCS, ALTCS, and Behavioral Health programs for the State of Arizona contracts held by Banner Health, as well as any Medicare Advantage aligned network, as mandated by State contract. Monitors, reports and ensures compliance with requirements related to network adequacy, availability and any other regulated standards or requirements. Develop strong partnerships with the contracted providers ensuring their commitment to competitive rates and regulatory compliant performance.

6. Collaborates with Delivery System Service line leads and providers in the development and ongoing management of specialty High Value Networks. Provide leadership in the evaluation and development of HVN networks. Coordinate across plan operating departments and delivery system departments and provider office management to ensure strong implementation and ongoing management. Ensure quality performance metric s are developed and reported on an ongoing basis within and across the HVN’s.

7. Collaborates with government program leadership (Pioneer, MSSP, AHCCCS, CMS, and other shared savings and CMS improvement programs) to ensure a strong compliance provider network to support the requirements of the government program structures. Ensures strong interface between provider offices, network management team and government program teams for optimal network performance under the various regulatory requirements.

8. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure safeguards, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved. Ensures delegated oversight of vendors performing delegated functions on behalf of Banner Health Insurance Division.

MINIMUM QUALIFICATIONS

Bachelor’s Degree in a relevant field or equivalent level of education and experience.

Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver’s License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.

Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five years of progressively responsible managerial experience, including a minimum of two years management level experience within a healthcare system setting or large multi-operational, complex corporate environment.

Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferable.

Proven track record of driving successful performance outcomes and accomplishing organizational goals.

Must demonstrate skills and business acumen through direct leadership experiences such as: Anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.

PREFERRED QUALIFICATIONS

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