Director, Case Management at Bright Health
- Build and oversee care management teams and solutions that yield industry-leading medical cost outcomes while aligning with Bright’s Care Partner philosophy.
- Collaborate with Bright’s Medical Directors to establish clinical strategies that enhance program performance and align with Bright’s core objectives, policies, and values
- Support development and ensure compliance with policies and procedures related to corresponding Care management functions
- Coordinate with other leaders of internal and delegated functions at Bright, including utilization management, clinical market teams, claims and line of business leaders, to identify opportunities to smooth the member and provider experience across programs.
- Contribute to the development of methodology and processes to measure, and evaluate, ongoing clinical program performance
- Establish monitoring processes to validate and document that all of Bright’s CM processes meet all applicable accreditation standards and State and Federal regulatory requirements
- Participate in and/or lead the implementation of new clinical initiatives and/or new market installations in relation to care management
- Develop and maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels (e.g. average speed of answer and abandonment rates)
- Represent the Care Management functions within Bright Committee structures to report program performance and provide operational updates, reporting program performance and operational updates.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree in a related field required. An RN or other clinical licensure is preferred, but not required.
- Eight (8) or more years of professional experience, including five (5) years developing and/or managing clinical programs, products and services required.
- Two (2) years of experience working within a care management or care coordination operation required.
- Experience with Medicare and SNP population case management strongly preferred
- Prior experience with URAC accreditation strongly preferred.
- Formal training in Six Sigma management techniques preferred.