Manager, Clinical Market Performance at Bright Health

| Remote
Sorry, this job was removed at 2:43 p.m. (CST) on Wednesday, September 30, 2020
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ABOUT THE ROLE
This individual manages a geographically dispersed market-based team of regional and local clinical market nurses, clinical consultants, and quality nurses. The Manager, Clinical Market Performance is responsible for establishing and maintaining working relationships with Care Partner (health care provider) clinical leadership and is accountable for the deployment and scaling of clinical operations including quality gaps, risk adjustment, and clinical program governance – based on Care Partner programs. This individual is also accountable for key results, such as utilization, network keepage, accurate risk adjustment, and quality. 
This remote position will oversee one of two of these Markets: Phoenix, Denver.

YOUR RESPONSIBILITIES

  • Engage Care Partners to effectively achieve clinical performance goals using continuous innovation and improvement through dynamic leadership.
  • Launch and sustain clinical operations in new markets, including establishment of market-specific clinical roadmaps with Care Partners that span the functions of health optimization (population health management, quality, coding performance, accreditation, pharmacy management, and data and analytics).
  • Build an in-depth understanding of internal and external tools and reports available to you and the regional team to orchestrate a coordinated workflow that equally prioritizes the care of the member, Bright Health’s mission, and the care partner.
  • Oversee referral of members to utilization management and care management while providing collaborative support to market team/care partner on strategies to improve these processes.
  • Oversee surveillance of high-risk members, tracking, and trending outcomes of care management/complex care management (CM/CCM) activities.
  • Support quality and risk process by working with internal teams and collaborating with care partner to request, review, and abstract medical records for HEDIS, quality of care concerns, quality improvement programs, and care coordination, including electronic and paper medical records.
  • Thoroughly understand and organize market performance operations to effectively design and apply our collective intervention set, meet utilization, keepage, quality and risk targets, monitor and report our performance, and advance and enhance programs.
  • Manage a team of nurses and clinical consultants (analysts) across geographies. This includes working with nurses to ensure competencies and productivity targets are met and that nurses are working efficiently at the top of their licenses.
  • Build innovative programs through interaction and collaboration with Care Partner clinical leaders, which requires detailed knowledge of health systems, clinically integrated networks, advanced primary care groups, and risk contracts.
  • Regularly revise strategy and tactics to address market needs.
  • Convene and lead cross functional teams to mobilize resources within Bright and Care Partners to address issues and to develop processes/relationships.
  • Design and deploy a network optimization approach, in concert with Network and Analytics teams.
  • Work cross functionally to represent the clinical market perspective in design and deployment of non-clinical programs.
  • Lead STARs/quality improvement efforts in the Region.

 

SUPERVISORY RESPONSIBILITIES

  • This position has responsibility for supervising a team of nurses and clinical consultants. 

 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in nursing or related field and current license to practice as a nurse
  • An advanced degree such as a Master of Business Administration (MBA), Master of Health Administration (MHA), Master of Public Health (MPH), or equivalent degree is preferred.
  • Five (5) or more years of leadership experience managing care management and quality improvement nurses in payor or provider organizations is required
  • Five (5) or more years of experience with clinical operations, strategy, services, and/or operations in an integrated delivery system or clinically integrated network is required
  • Experience in some or all the following areas related to value-based care: population health, quality, coding, and health care analytics is desired

 

PROFESSIONAL COMPETENCIES

  • Highly organized and process driven
  • Ability to manage teams across geographical locations
  • Comfortable delivering professional presentations to an audience
  • Exceptional communication skills and will thrive when asked to deliver our unique and differentiated value proposition
  • Proficient in the use of Microsoft Office applications including Outlook, Word, Excel, and PowerPoint

 

LICENSURES AND CERTIFICATIONS

  • Current license to practice as a nurse is required.

 

WORK ENVIRONMENT

  • Most work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
  • Videoconferencing is used frequently.
  • Travel is required. 

 

 

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: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing 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
    • .NETLanguages
    • C#Languages
    • JavascriptLanguages
    • PythonLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • Node.jsFrameworks
    • MongoDBDatabases
    • TSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • JIRAManagement
    • Microsoft ProjectManagement

Location

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

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 you make yourself accessible to the rest of the team?

Modeling after my manager, I like to provide both regularly scheduled one-on-one meetings, where developers and engineers get to set the agenda. We can talk about career development, design and architecture ideas, industry trends, or traditional HR topics like goal setting. It’s up to them. I also have begun setting regular “office hours.”

Amy

VP & Data Platform Architect

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 put 3% of your total earnings into your 401K plan and you are immediately vested in that. 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 stand up
Open door policy
Team owned deliverables
Team based strategic planning
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Mean gender pay gap below 10%
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
Onsite Gym
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
Company Equity
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.
Family Medical Leave
Employees who have been with the company for 12 months are eligible for 12 weeks of family medical leave.
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Paid Holidays
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Professional Development Benefits
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