Director of Operations - Utilization Management Intake at Bright Health

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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 Director of Operations – Utilization Management Intake, will drive excellent provider service within the Utilization Management function by oversight of BPO partners as well as internal staff and management. The position will ensure execution against phone and fax management service goals such as average speed of answer and turnaround times, and will also oversee non-clinical staff who support clinical Utilization Management functions. This leader will be accountable for driving continuous improvement in quality performance and also administrative cost efficiency of the function. This role will be active in the hiring and development of their team as well as structure and evolution of use in offshore resources. The Director will also apply deep knowledge of regulatory requirements to ensure compliance of other non-clinical tasks completed by the team. The Director will work closely with the Utilization Management, Care Management, Delegation oversight, Provider Call Center, and Network-facing leadership teams.

ROLE RESPONSIBILITIES

  • The Director of Operations – Utilization Management Intake job description is intended to point out major responsibilities within the role, but it is not limited to these items.
  • Manage the daily operations and production of UM non -clinical staff to meet internal SLAs and external accreditation and/or regulatory timeframes
  • Ensure appropriate usage of resources in order to facilitate the UM process. Coordinate projections from workforce management and scheduling analysts with supervisors from both offshore and onshore teams to ensure high service and throughput
  • Ensure compliance within applicable accreditation standards, federal and state requirements, and line of business service delivery guidelines, including education of staff for consistent compliance to guidelines
  • Assist with the hiring, development and evaluation of UM non-clinical staff including corrective actions and terminating as needed. Oversee performance of vendor non-clinical staff to ensure productivity and quality standards are consistently met
  • Evaluate compliance policies and procedures and recommend enhancements
  • Assist with ensuring consistent data collection from UM non-clinical staff that is used to assist the company in achieving corporate goals to improve monitoring and reporting in order to meet external requirements
  • Identify opportunities for quality and process improvements necessary to facilitate department functions
  • Educate staff as necessary to ensure consistent performance and adhere to standards
  • Support coordination of Bright programs through maintenance and oversight of cross-functional communication and referral procedures
  • This position will manage a team of Non-Clinical Staff and will oversee offshore resources via a BPO relationship.
  • 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.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects is required.
  • Three (3) or more years of utilization management/ healthcare operations/ quality improvement experience, in a managerial capacity is required.
  • Working knowledge and understanding of basic utilization management and quality improvement concepts.
  • Previous experience working with offshore vendors and resources preferred. 
  • Prior experience with highly regulated environment including federal, state and national accreditation standards preferred.

PROFESSIONAL COMPETENCIES

  • Experience with problem management, change control and how to influence change without direct control within a decentralized business unit culture.
  • Experience managing teams with high visibility across products/business capabilities with experience identifying and managing dependencies within and across teams preferred.
  • Excellent writing skills, particularly in determination notification writing.
  • Ability to develop strong cross-functional and collaborative relationship with internal and external partners, including the ability to work with a wide variety of people and personalities. 
  • Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative environment.
  • Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities.
  • Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.

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!

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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 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!

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