Director, Risk Adjustment Member Engagement 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.

Bright Health’s Risk Adjustment Team is working to push boundaries to redefine what risk adjustment and member engagement programs can accomplish in health care. The Director, Risk Adjustment Member Engagement is a thought partner to all areas of Bright’s Medicare Advantage and Individual and Family Plan (IFP) businesses and will contribute to a culture of theory testing and data-driven decision making. The Director, Risk Adjustment Member Engagement will be comfortable speaking both ‘business’ and ‘data’ with our internal teams and external vendors to understand business questions, develop ways to answer those questions, and communicate those answers to stakeholders.

ROLE RESPONSIBILITIES

  • 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

PROFESSIONAL COMPETENCIES

  • 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.

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
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    • ScalaLanguages
    • SqlLanguages
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    • D3JSLibraries
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    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
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    • MongoDBDatabases
    • MySQLDatabases
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    • 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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