NeueHealth Compliance Manager

| Remote
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.

YOUR RESPONSIBILITIES

  • 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

PROFESSIONAL COMPETENCIES

  • 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

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
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    • Aha!Management
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    • Microsoft DynamicsCRM

Location

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

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
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
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!

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