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

Manager, Clinical Performance - Appeals at Bright Health

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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 Clinical Manager, Utilization Management, will oversee daily operations of Bright Health’s Utilization Management (UM) clinical staff. This role will be active in the hiring and development of their team. Responsibilities include applying deep knowledge of clinical information and regulatory requirements to daily operations. The Supervisor will work closely with the Director, Utilization Management to drive performance on the UM team.

ROLE RESPONSIBILITIES

The Clinical Manager, Utilization Management job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Supervise the daily operations and production of UM staff and Ensure appropriate usage of resources in order to facilitate the UM process
  • Ensure appropriate usage of resources in order to facilitate the UM process
  • Ensure compliance within applicable Accreditation standards, Federal and State requirements, and line of business service delivery guidelines. Including education of staff for consistent compliance to guidelines
  • Assist with the hiring, development and evaluation of UM staff including corrective actions and terminating as needed
  • Evaluate compliance policies and procedures and recommend enhancements
  • Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements
  • Identify opportunities for quality and process improvements necessary to facilitate department functions
  • Educate staff as necessary to ensure consistent performance and adhere to standards
  • Support coordination of Bright programs through maintenance and oversight of cross-functional communication and referral procedures
  • Other tasks as assigned

SUPERVISORY RESPONSIBILITIES

  • This position will supervise a team of Utilization Management clinicians.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s or Associates degree in Nursing required.
  • 3 (three)+ years of utilization management/quality improvement experience.
  • Working knowledge and understanding of basic utilization management and quality improvement concepts.
  • Previous experience as a lead in a functional area 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

  • An active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license to practice as a health professional in a state or territory of the United States is required for this role.

WORK ENVIRONMENT

  • 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.
 
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
    • RubyLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ASP.NETFrameworks
    • ExpressFrameworks
    • Node.jsFrameworks
    • Ruby on RailsFrameworks
    • SparkFrameworks
    • SpringFrameworks
    • HiveDatabases
    • Microsoft SQL ServerDatabases
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • Aha!Management
    • ConfluenceManagement
    • JIRAManagement
    • Microsoft ProjectManagement
    • Microsoft DynamicsCRM
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What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 2 different health insurance plans, all through BlueCross Blue Shield (HDP & 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 4% 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. Last Wednesday of every month is reserved for WellBeing Wednesday where we don't schedule any meeting that day so our employees can focus on deep work or learning something new.

Culture
Volunteer in local community
Partners with Nonprofits
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
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (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
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
Tuition Reimbursement
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Time allotted for learning
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

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