Manager, Clinical Market Performance at Bright Health
- 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.
- 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
- 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.
- 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.