Director, Risk Adjustment Member Engagement at Bright Health
- The Director, Risk Adjustment Member Engagement job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Lead a matrixed team analysts and vendor managers to drive risk adjustment performance for both Medicare Advantage and Commercial/ACA members
- Provide thought leadership to build an Risk Adjustment function from the ground up, including the co-creation of an analytics and programmatic capabilities agenda that distinguishes Bright from competitors.
- Leadership and overall program management for retrospective and prospective encounters facilitation, In-Home visits, virtual visits and in-office assessment. Accountable of ROI of all programs
- Collaborate with Actuarial and Analytics teams to design and implement suspecting and segmentation strategies for use in prospective and retrospective programs.
- Develop short-term, quick-win functionality as well as longer-term, analytics based. gap closure programs and tools
- Communicate complex concepts to non-technical business stakeholders across the entire business cycle, from question identification through results interpretation, and including communication about data integrity.
- Collaborate with Bright’s Technology team to ensure that all data and vendor management infrastructure is functioning.
- Ensure Bright’s ability to meet compliance reporting requirements for federal and state level regulators on an annual cycle including RADV audits.
- Other duties and responsibilities as assigned.
- This position may have direct and indirect supervisory responsibilities for RA program execution and analytics functions.
- 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. Travel may be required.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Eight (8) or more years of experience in a health care Risk Adjustment field required.
- Three (3) or more years leadership experience managing and mentoring a teams
- Working knowledge of business intelligence tools and how they are used to drive business decisions.
- Bachelor’s degree in math, engineering, analytics or healthcare related fields, or High School diploma/GED and equivalent experience required.
- Expertise with risk adjustment analytics and vendor management strongly preferred.
- Experience with in-home and virtual engagement capabilities
- Strong ability to lead and mentor a highly skilled team
- Ability to frame an analysis from end-to-end in collaboration with business and technical stakeholders
- Expertise in the use of advanced data analysis to identify opportunities and design programs to capture value
- Experience managing third party service providers including TPA’s and chart related functions
- Eager learner, collaborative partner, easy communicator, and careful analyst
- Passion for empirical research and answering hard questions with data
BEHAVIORAL AND LEADERSHIP NORMS
- Bright Values: Exemplifies Bright Values. Leads by example. Is viewed as key leader in the company. Acts with quiet, calm determination. Effectively influences inside of the organization.
- Decision making: Has a strong voice and is a contributor in the decision-making process. Is sought out in the organization for input in driving to a decision. Makes decisions based on fact. Is capable of taking large sums of information, and drilling into what is important. Understands organizational impact of decisions and communicates effectively throughout the decision-making process. Pushes issues to resolution.
- Delivers Results: Is extremely results oriented. Is capable of deciphering priorities for self and for others, and focuses the group on what must be done today and who must do what. Focuses on results, not effort, and is able to efficiently direct time and energy to achieving intended outcome. Can successfully develop a budget and achieve it without sacrificing quality of output. Achieves strong results within functional area and understands organizational impact. Excellent track record of achieving or surpassing expected results. Understands how to operate in collaborative framework; results in a functional area should not come at expense of other team or function.
- Direct and Indirect Management: Makes decisions that benefit Bright over self. Is developing within the framework of the Bright Leadership Model, and can successfully influence direct and indirect teams to achieve goals. Organizes people and resources toward the effective and efficient pursuit of objectives: this includes hiring, firing, supervising and performance appraisals. Delivers thoughtful and constructive feedback to teams, and actively works to develop those around them. Knows how to make tough personnel decisions. Sets an example for employees. Is sought after by peers for 360 feedback. Manages up appropriately and knows how and when to escalate an issue or situation to more senior manager.
- Planning and Execution: Identifies need for planning and has skills to develop, implement, monitor and achieve plans. Knows how and when to adjust plan. Leads others in this effort. Hold self and team accountable for effective planning and execution. Overcomes hurdles.
- Presence: Excellent communication skills and represents Bright well. on various occasions, participates in external meetings (ex. With Care Partners, vendors, regulatory bodies, etc.). Internally, leads large and small groups of people in meetings. Capable of developing thoughtful agenda, setting objectives, driving clarity of purpose and delivering the intended results. Instills confidence in others.