Quality Manager at Bright Health

| Remote
Sorry, this job was removed at 6:27 a.m. (CST) on Wednesday, July 28, 2021
Find out who's hiring in Austin.
See all Developer + Engineer jobs in Austin
Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

The role of the Quality Manager is to support Quality Improvement through leading assigned Risk Adjustment and HEDIS initiatives throughout the enterprise. The role serves as a key quality of care driver by ensuring provider engagement, ensuring IT capabilities, planning, and prioritizing for the end-to-end for all Quality initiatives. The QM Manager is an operational leader that will ensure implementation of the Neuehealth QM Program. 

ROLE RESPONSIBILITIES

  • 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.

SUPERVISORY RESPONSIBILITIES

  • 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

PROFESSIONAL COMPETENCIES

  • 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

PERFORMANCE EVALUATION

  • 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.

ABOUT US
 
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology, and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized, and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities, we are reshaping how people and physicians achieve better health together.
 
We’re Making Healthcare Right. Together. 

We've won some fun awards like Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our team!
 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!

Read Full Job Description
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
    • Node.jsFrameworks
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • Aha!Management
    • ConfluenceManagement
    • JIRAManagement
    • Microsoft ProjectManagement
    • Microsoft DynamicsCRM

Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.
Making Healthcare Better For All At Bright Health
Watch

An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 3 different health insurance plans, all through Cigna (HDP, Premium HDP and PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We have a Lifestyle Spending Account and options for HSA/FSA. We put 3% of your total earnings into your 401K plan and you are immediately vested. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks.

Culture
Friends outside of work
Eat lunch together
Daily sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Unconscious bias training
Someone's primary function is managing the company’s diversity and inclusion initiatives
Mean gender pay gap below 10%
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Bright Health employees can contribute up to $3500 annually to their FSA.
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We will put 3% of your total earnings into your 401K plan, even if you don't put anything in. It's a safe harbor contribution.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Remote Work Program
Family Medical Leave
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Online course subscriptions available
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

More Jobs at Bright Health72 open jobs
All Jobs
Data + Analytics
Design + UX
Dev + Engineer
Internships
Legal
Marketing
Operations
Product
Project Mgmt
Operations
new
Remote
Data + Analytics
new
Austin
Developer
new
Austin
Operations
new
Remote
Data + Analytics
new
Remote
Developer
new
Austin
Developer
new
Austin
Developer
new
Remote
Project Mgmt
new
Remote
Data + Analytics
new
Austin
Operations
new
Remote
Developer
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Austin
Project Mgmt
new
Austin
Data + Analytics
new
Austin
Operations
new
Remote
Marketing
new
Remote
Marketing
new
Remote
Developer
new
Remote
Product
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Remote
Developer
new
Remote
Data + Analytics
new
Remote
Developer
new
Austin
Operations
new
Remote
Design + UX
new
Austin
Data + Analytics
new
Remote
Developer
new
Austin
Project Mgmt
new
Austin
Operations
new
Remote
Operations
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Remote
Developer
new
Remote
Developer
new
Austin
Data + Analytics
new
Remote
Project Mgmt
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Remote
Operations
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Austin