SCOPE OF ROLEBright 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