“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!