Associate Director, RN Medical Management Services

Banner Health; Phoenix (AZ); Remote; Full time

Job summary

Join a leading healthcare organization as an Associate Director of RN Medical Management Services. In this fully remote role, you will oversee the RN Prior Authorization team while ensuring compliance and quality care delivery. We seek an experienced leader with a strong background in nursing and case management to guide our efforts to provide optimal patient care.

Benefits

Health and financial security options

Flexible work schedule

Competitive benefits packages

Qualifications

• Strong knowledge in nursing and case management.
• Excellent interpersonal and leadership skills.
• Experience in utilization management.

Responsibilities

• Lead teams of RN Prior Authorization Review Nurses.
• Assist with audits for Medicare Advantage plans.
• Promote a collaborative work environment.

Skills

Leadership

Interpersonal skills

Communication

Organizational skills

Education

Bachelor's degree in Nursing or equivalent experience

RN license in Arizona

CCM Certification or similar preferred

Job description

Associate Director, RN Medical Management Services

Join to apply for the Associate Director, RN Medical Management Services role at Banner Health

Associate Director, RN Medical Management Services

3 days ago Be among the first 25 applicants

Join to apply for the Associate Director, RN Medical Management Services role at Banner Health

Estimated Pay Range:

$46.84 - $78.06 / hour, based on location, education, & experience.

Department Name:

Prior Authorization

Work Shift:

Day

Job Category:

General Operations

Estimated Pay Range:

$46.84 - $78.06 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

Better Than Ever for Nurses. When we make things better than ever for nurses at Banner Health, we make things better than ever for all of us. This means investing in the holistic health and happiness of our nurses—through better pay, better benefits, better opportunities and a better community

As an Associate Director of Registered Nurse Medical Management, you will

you will be responsible for leading teams of RN Prior Authorization Review Nurses and the LPNs who make up the denial letter writing team. You will also work closely with the Director RN, Medical Directors, non-clinical and clinical team members, and leaders of other departments. Your responsibilities will also include assisting the Director RN with audits for Medicare Advantage plans and commercial insurance plans. Must have case management and prior authorization experience to be considered.

Your work location will be entirely remote. Your workdays will be Monday-Friday often 10-hour days. On call varies but may be required on Saturday when needs arise. This position does require residency in the state of Arizona. If this role sounds like the one for you, Apply today!

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life.

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 the support and implementation of programs and tactics used to influence provider and Plan consumer/beneficiaries’ behaviors in order to achieve right care in the right place at the right time and the appropriate cost. Plans and provides support for health plan consumers/beneficiaries to align with the objectives of triple aim. Plans and provides managerial leadership to team members within the department. This position supervises direct report personnel and participates in selection, orientation, counseling, evaluation and team scheduling. Promotes a collaborative, open and inclusive work environment in a highly matrixed organization. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes, provide oversight and coordination related to delivery of Medical Management services.

Core Functions

• Provides and/or facilitates medical management and/or other related activities and serves as a resource to other team members. Promotes interdisciplinary health plan consumers/beneficiaries’ care planning and supports Care Model.
• Periodic On-Call availability to address after hour health plan consumers/beneficiaries’ needs related to medical management.
• Hires, trains, and conducts performance reviews, and directs the workflow for the team. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.
• Evaluates and implements departmental processes to support Strategic Initiatives as determined by Banner Health Network.
• Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes. Acts as a consultant within the organization and community.
• Analyzes data and healthcare trends to gain efficiencies and improve health plan consumers/beneficiaries’ outcomes. Acts as change agent to lead team through necessary modifications of processes, workflows, and/or delegated requirements.
• Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
• This position is facility/entity based, providing leadership within medical management to ensure quality outcomes and resource efficiency. Internal customers include all levels of nursing leadership and team members, medical staff and all other members of the interdisciplinary healthcare team. External customers include physicians, payers, community agencies, provider networks and regulatory agencies.
  
  

Minimum Qualifications

Must possess a strong knowledge of nursing, case management or healthcare related field as normally obtained through the completion of a bachelor's degree or equivalent experience.

Requires current Registered Nurse (R.N.) license in state worked.

Requires extensive knowledge in the areas of case management and utilization management. Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources. Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. In BPA (Banner Plan Administration) setting, requires an understanding of reimbursement methodologies.

Preferred Qualifications

Related certification(s) such as CCM, Certified Case Manager, MCG Certification(s), RN-BC Registered Nurse Case Manager, CMAC, Case Management Administrator preferred.

Additional Related Education And/or Experience Preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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