“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.
ABOUT THE ROLE
The NeueHealth Compliance Manager will manage the NeueHealth compliance program, with a particular focus on overseeing and managing external audits initiated by health plan customers and regulators. Additionally, they will be responsible for implementation of an effective clinical oversight and monitoring process grounded in accountability and program transparency. Further, they will work with-in operations to design process, procedure, and appropriate controls for the Neue Heath business unit. The compliance Director will also oversee and mange compliance matters involving BHC’s business offerings to include Managed Services Organization( MSO) business, medical practices, leased networks, and other related services, and also provide general compliance support for NeueHealth and chair and lead a compliance oversite committee dedicated to NeueHealth.
- Responsible for the implementation of the clinical oversight and monitoring program for BHC based on payor delegation of services
- Responsible for collaboration with Enterprise Analytics to establish the key performance indicators (KPI) to support Program Integrity
- Responsible for implementation of the UM and PHM Program audits based on accreditation, regulatory requirements, contractual obligations, and documented policies and procedures
- Responsible for leading RCAs and developing Performance Improvement Plans (PIP) based on KPIs or process deficiencies
- Responsible for organizing the Health Plan pre-delegation and annual delegation audit process and documents; to include, scheduling, collection of evidence of compliance, and communication of audit findings
- Responsible for coordination with key stakeholders for Health Plan Corrective Action Plan development, implementation, and monitoring
- Responsible for ensuring data validation and timely submission of reports based on the Health Plan contracts; to include, but not limited to, monthly program reports, workplans, and evaluations
- Further, they will work with-in operations to design process, procedure, and appropriate controls
- Responsible for remaining current on regulatory changes and ensures knowledge transfer to appropriate key stakeholders
- Lead a corporate compliance subcommittee dedicated to BHC and its specific compliance risk and activities
- Help coordinate the delivery of other compliance related functions focused on BH to include training, communication, monitoring/auditing, investigations, risk assessment/workplan, etc.
- Adheres to the Policies and Procedures set forth by the Bright Health Care and performs all additional duties as assigned
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree required
- Five (5)+ years’ experience with health plan compliance experience
- Knowledge of industry standard health plan compliance practices, CMS Medicare Advantage requirements, and applicable state insurance laws
- Strong written and oral communication skills
- Experience organizing and managing large volumes of information and data in effective and efficient systems
- Project management experience
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.