Chief Medical Officer – Medicare Advantage

| Remote
ABOUT THE ROLE
The Chief Medical Officer for Medicare Advantage is responsible for three major areas: 1) overseeing the clinical teams that operate within MA Clinical Programs and Operations and establishing a clear strategy and direction for their work; 2) in concert with the Clinical Market Performance team establish effective external relationships with health system physician leaders focused on establishing and executing against market population health, risk, and quality targets, and 3) direct oversight and leadership of Utilization Management. The CMO will also support the Chief Operating Officer of MA in STARs/HEDIS and Risk Adjustment strategy and execution.

YOUR RESPONSIBILITIES

  • Establish the strategy for population management for the Medicare Advantage line of business in each market
  • Support development of the tenets of our overarching population health, risk adjustment, and quality/Stars strategies at Bright Health
  • Represent Bright Health externally at selected conferences, in key professional bodies, with Care Partner clinical and other executive leadership, with media and in other venues
  • Establish the strategy and oversee the medical functions of the utilization review/management and quality assurance including the technology, teams, and reporting for these functions
  • Build and manage a team of clinical experts to ensure effective population health management and Care Partner interactions in collaboration with the Clinical Market Performance team
  • Lead Bright Health’s clinical staff; recruit and assist in the recruitment of key clinical staff
  • Support population health staff to ensure timely and consistent responses to members and Care Partners
  • Act as lead clinical liaison to network providers and facilities to support the effective execution of population health, risk adjustment, and quality/Stars programs
  • Provide oversight and business direction for the following activities, including but not limited to:
  • Formulary development
  • Pharmacy and Therapeutics management
  • Credentialing
  • Utilization Management
  • Clinical Compliance
  • Quality Management and Programs
  • Risk Accounting Programs
  • Appeals and Grievances Review
  • Network Management and Evolution
  • Provider Relations
  • Market-level clinical management and program development
  • Provides clinical consultation to departments throughout and outside the Medicare Advantage organization, including:
  • Network
  • Operations
  • Customer Experience
  • Care Partner Integration
  • Marketing
  • Communications
  • Participate in the establishment of path-to-value activities with Care Partners leading to advance value based payment models
  • Oversee clinical teams and vendors in partnership with the Population Health Operations team to ensure timeliness in meeting all required Federal and State turnaround time on clinical decision making, including but not limited to: decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines, and the ability to participate in second review of group decision must often occur in 24 hours
  • Periodically consults with other practitioners in the field

SUPERVISORY RESPONSIBILITIES

  • This position has supervisory responsibilities for the all Medicare Advantage Medical Directors

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree required; Master of Public Health (MPH), Master of Health Administration (MHA) or Master of Business Administration (MBA) is preferred
  • Ten (10) or more years of experience in Clinical Practice and/or Health Care Industry is required
  • Ten (10) or more years of direct clinical care in private and/or academic practice that includes oversight of direct patient care is required
  • Post-graduate experience in direct patient care is required
  • Previous leadership experience in a clinical oversight role is required
  • Previous Medicare and/or Commercial insurance industry experience preferred

PROFESSIONAL COMPETENCIES

  • Ability to meet all required Federal and State turnaround time on clinical decision making, including but not limited to; decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines
  • Ability to participate in second review of group decision must often occur within 24 hours
  • Demonstrated knowledge of established medical management and clinical services
  • Strong interpersonal and communication skills
  • Commitment to carrying out professional responsibilities and an adherence to ethical principles

LICENSURES AND CERTIFICATIONS

  • An active, unrestricted MD or DO license in the state of practice or operation is required; MD or DO US Board certification (specialty certifications acceptable) from the appropriate medical licensing board is preferred

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: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing 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!

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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
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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 put 3% of your total earnings into your 401K plan and you are immediately vested in that. 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
Unconscious bias training
Mean gender pay gap below 10%
Diversity Employee Resource Groups
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
Company Equity
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!

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