Quality Manager at Bright Health
- Capacity to provide analytical support and synthesize Medicare Risk Adjustment and HEDIS/Quality Measure data and provide interventions for optimization
- Develop partnerships with key stakeholders (Quality, Provider Relations, Practice Management, IT etc.) to communicate and implement risk adjustment strategies and HEDIS performance improvement opportunities; to include training/curriculum development
- Responsible for implementation of the Quality Initiatives defined by the Quality Improvement Committee; ability to lead QIC meetings when required
- Support implementation of the risk adjustment and HEDIS workflows and operating procedures within each market
- Responsible for informing key stakeholders of risk adjustment and HEDIS changes and ensures appropriate operational responses to changes.
- Lead the clinical documentation improvement efforts; to include, validation of supplemental data for HEDIS and Risk Adjustment
- Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required. Ability to lift at least 50 pounds.
- This position may have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree
- Minimum 1 year of experience with Medicare Risk Adjustment coding and HEDIS
- Comprehensive knowledge of CMS updates impacting Hierarchical Condition Categories (HCCs), ICD 10 coding, and Medicare/HHS risk adjustment models, NCQA Technical Specifications
- Project Management experience, preferred
LICENSURES AND CERTIFICATIONS
- Active and unrestricted license as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN), preferred
- High Attention to detail and strong analytical skills
- High level of critical thinking and problem-solving skills
- Strong work ethic and overall positive attitude
- Effective communication skills including verbal and written
- Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
- Demonstrated flexibility, organization, and self-motivation
- Highly adaptable to change
- Meets Requirements: Evidence the employee performs all functions indicated in the Job Description.
- Exceeds Requirements:
- Evidence the employee performs all functions indicated in the Job Description AND
- Exceeds target for the defined performance metrics AND
- Able to identify opportunities to improve AND can communicate in writing an effective performance improvement solution for the team.
BEHAVIORAL AND LEADERSHIP NORMS
- Bright Values: Lives the Bright Values. Is focused on bravery needed to develop a variety skills. Not afraid to ask questions or take risks. Focuses on purposeful planning and objective setting. Focuses on the team’s successes, and how to support that effort.
- Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented and works on generating input from multiple constituents and driving the team to a solution. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.
- Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Works with manager or appropriate liaison in the organization to work through goal setting and milestone development to ensure timely and high-quality work product. Achieves strong results within functional area. Is focused on managing against a predetermined set of objectives, and creates and follows process. Delivers outstanding and sustained results.
- Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can drive the business forward and how the bigger picture works. Actively participates in his/her own career development.
- Multi-tasking: Balances multiple projects and initiatives at any given time. Alongside manager or appropriate Bright teammate, re-evaluates priorities based on changing company needs to understand what must be done today. Able to balance multiple projects and initiatives at any given time. Capable of deciphering which priorities are most important for the function/organization. Consistently meets deadlines.
- Training and Mentoring: Helps train and mentor others: Actively participates in the onboarding and ongoing success of teammates. Onboards, trains and provides informal mentorship to new and existing teammates (interns, consultants, etc.). Provides thoughtful solutions, direction and advice to others, and help advise on priorities.
- Upward Management: While balancing multiple initiatives, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.