Bright Health
Through powerful relationships with care partners, Bright Health aims to help people live healthier and brighter lives
Austin, TX
Remote

Director, UM Quality & Delegation Oversight

| Remote
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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


SCOPE OF ROLE
The Director of UM Quality & Delegation oversight will create, oversee and manage the program and team that provides quality oversight of the clinical operations of internal, offshore, and delegated utilization management programs. This role will direct in the hiring and development of their team. Responsibilities include applying deep knowledge of clinical information, regulatory, and accreditation requirements to evaluate, audit the daily and overall operations and programs of delegated UM vendors and/or internal UM teams.   In the future, this role may support oversight of care management programs and or oversight of delegated providers.  
 
This position will also oversee a team that handles escalated questions and concerns from Provider Relations and Clinical market-based teams for UM cases that cross internal, offshore, and delegated Vendor partners. 
The Manager will work closely with the AVP, Clinical Performance. Director, Utilization Management Operations, and Accreditation and Compliance teams to drive performance on the overall utilization management program operations and performance for delegated vendors and internal service delivery teams.  
ROLE RESPONSIBILITIES
  • The Director, UM Quality and Delegation Oversight job description is intended to point out major responsibilities within the role, but it is not limited to these items.
  • Lead, develop, report and supervise the daily operations and work of the UM Quality audit staff to ensure Bright, offshore, and delegated UM teams meet accreditation and regulatory standards  
  • Build Quality oversight tools and programs that ensure compliance against Accreditation and Regulatory standards, oversee execution   of quality audits, and report outcomes of audits.
  • Work with Compliance and Accreditation teams to identify Corrective Actions needed by any team or organization and partner with those   teams to ensure quick improvement against quality findings.  
  • Lead, develop and manage a process to respond, solution and provide guidance to address any operational questions and/or escalated UM cases from delegates, Care Partners, providers, and internal staff and colleagues.
  • Create and implement policies related to corresponding UM quality program and delegation oversight. Coordinate with UM Operations, Medical Policy, Accreditation, and Regulatory teams to ensure policies are in compliance with Accreditation and Regulatory standards. 
  • Identify opportunities for quality and process improvements necessary to facilitate departmental and programmatic functions.
  • Serve as a member of Bright Health’s UM Committee, reporting UM program performance and associated operational updates as well   as managed workplans and prioritize resources to meet key deliverables. 
  • Support coordination of Bright programs through maintenance and oversight of cross-functional communication and referral procedures with other departments including Clinical Market Performance, Appeals and Grievances, Care Management, Member and Provider Services, Special Services Team, Care Navigation, etc.
  • This position will supervise a team of Quality audit Supervisors, clinicians and non-clinical specialists.
  • 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
  • A Bachelor’s Degree in business, healthcare administration, nursing, or a related field is required; MBA/MHA and/or clinical degree is preferred
  • 5 (five)+ years of utilization management/quality improvement experience. 
  • Working knowledge and understanding of basic utilization management and quality improvement concepts.
  • Previous experience as a manager of a functional area and/or managing cross functional teams on large scale projects. 
  • 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 supervising 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.
LICENSURES AND CERTIFICATIONS
  • Active, current state’s RN license preferred or other applicable professional licensure/certifications
  • Certification in Healthcare Compliance (CHC) and/or Certified Compliance & Ethics Professional (CCEP)
 
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          
 
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.
 

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Where we are

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.

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

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!

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

Bright Health Careers In Austin
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JOB DUTIES AND RESPONSIBILITIES The Compliance Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items. Create, maintain and publish plan and benefit materials based on regulatory requirements and product lifecycle deadlines. Technical writing of, and revisions to, policy forms to ensure compliance with regulatory standards and developments. Track regulatory filings through SERFF, CMS Enterprise Portal, and other applicable filing systems.

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Director, Market Development

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Bright Health
Austin
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Software Engineer, Data Enablement

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Product Manager, Bright Enablement

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, National Market Operations

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, Utilization Management

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, IFP Customer Success – Multicultural Strategy Execution

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Manager, Case Management

Bright Health
Remote
1 week ago
Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

Desktop Support Specialist - CRM Admin

Bright Health
Austin
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Software Engineer 1

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Business Analyst - Risk Adjustment

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Telephony Engineer

Bright Health
Austin
2 weeks ago
RESPONSIBILITIES Customer support, training, and communication Configuration, integration, and troubleshooting end user applications Administration of end user application Maintenance of end user applications

Director, Operations

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. User Experience Designer

Bright Health
Austin
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior IT Project Manager - Infrastructure

Bright Health
Austin
2 weeks ago
ROLE RESPONSIBILITIES Manage different types of projects including those around enterprise Digital Asset Management, CRM platforms, Digital Experience application development, solution orchestration and integration, product selection and implementation, upgrades and deployments and operational efficiency improvements Be able to pull together numerous aspects of a proposed solution, to create a cohesive and organized plan, motivate resources to execute on that plan, and drive the plan through to its final and committed completion Bring clarity to project objectives, plan and deliverables such that conflicts are minimized

Data Analyst

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, Security Engineering

Bright Health
Austin
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Provider Analytics Consultant - Smart Networks

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Technical Project Manager

Bright Health
Austin
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Manager - Smart Networks

Bright Health
Remote
3 weeks ago
The Manager, Network Strategy job description is intended to point out major responsibilities within the role, but it is not limited to the following: Manage Network Strategy team members and support strategy and network development efforts. Drive advancement of network design strategy, overseeing development of proprietary Bright standards, alignment to regulatory requirements, and evaluation of development needs across both active and new markets. Set performance standards for Network and Market teams regarding network construction for active and new markets, partnering cross-functionally to advance Bright’s performance and footprint.

Manager - Smart Networks

Bright Health
Remote
3 weeks ago
The Manager, Network Strategy job description is intended to point out major responsibilities within the role, but it is not limited to the following: Manage Network Strategy team members and support strategy and network development efforts. Drive advancement of network design strategy, overseeing development of proprietary Bright standards, alignment to regulatory requirements, and evaluation of development needs across both active and new markets. Set performance standards for Network and Market teams regarding network construction for active and new markets, partnering cross-functionally to advance Bright’s performance and footprint.

Analytics Consultant

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Lead Business Analyst

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Ruby on Rails Developer

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Manager, Behavioral Network Development

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Software Engineer

Bright Health
Austin
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be