Director, Medical Cost Management at Bright Health
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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
The Director, Medical Cost Management is a critical part of the Bright Health Plan Texas Market leadership team and is responsible for development and implementation of strategies to manage and mitigate medical costs trend, thus enabling the provision of affordable products to members. This role requires the appropriate background and experience to partner with clinical, network, pharmacy and local market leadership to identify and implement cost savings action plans. This role is responsible for medical cost management activities across multiple lines of business: Individual and Family Plan, Medicare Advantage and Employer. Responsibilities include leading all market based medical cost activities and potentially a market based unit. Position is accountable for defining priorities and implementing timely solutions, in collaboration with cross-functional senior leaders.
The successful candidate will be a self-starter with a proven track record of succeeding in fast-paced and complex health care settings. It requires using data to make informed recommendations to business process impacting both external and internal stakeholders and be able to proactively optimize solutions. The candidate will lead with accountability; have excellent verbal and written communication skills and operate with strong attention to detail. Colleagues and clients would recognize the candidate for leading through influence, having empathy towards others, being highly collaborative and strongly exhibit ability to drive towards measurable outcomes.
The Director, Medical Cost Management job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Assess and develop immediate Medical Cost management initiatives for Texas
- In collaboration with the Finance Cost Management team, identify cost trends for quantification and prioritization for the Texas Market
- Partner with business leaders (clinical, network, pharmacy, etc.) to develop solutions to manage identified medical cost risks and opportunities for the Texas Market. Ensure measurement of outcomes of implemented solutions.
- Other duties as assigned.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Bachelor’s degree (Required), Master’s Degree Preferred
• 10 (ten) or more years of progressive experience in managed healthcare, with emphasis on developing and implementing programs to manage costs (Required)
• 7 (seven) or more years of experience in managing to affordability targets (Required)
• Strong clinical and network contracting background
• Advanced proficiency with Microsoft Excel and Microsoft Power Point (Required
• Familiarity with Tableau and other reporting tools.
• Broad health care background with knowledge and experience in both medical and pharmacy benefits
• In depth knowledge of potential cost drivers; clinical, network, utilization trends including high cost specialty medications.
• Proven ability to manage to affordability targets
• Skilled at working with vendors to support cost containment
• Proven ability to collaborate with BH risk-based partners in identifying and solutioning for cost drivers
• Strong collaboration skills to effectively design cost mitigation solutions that meet the business needs
• Ability to initiate and oversee success of cost mitigation/cost drivers
• Ability to perform critical analysis of complex business problems and propose appropriate solutions
• Experience and strong influential skills to manage cross-functional, virtual teams
• Excellent written and verbal communication skills
• Ability to understand and identify regulatory and implementation risks and develop mitigation strategies
• Ability to perform multiple tasks and prioritize simultaneously
• Ability to effectively engage and interact with and influence internal executive sponsors
• Advanced time management, project management, and analytical skills
• High attention to detail
• Strong analytical skills, work ethic, problem solving ability, and overall positive attitude
• Demonstrated flexibility, organization, and self-motivation
• Adaptable to change
LICENSURES AND CERTIFICATIONS
• No licensures and/or certifications are required for this role.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.