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

Quality and Compliance Manager (Healthcare) 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.


The Quality and Compliance Manager will serve as the leader responsible for managing aspects of the clinical quality, compliance and auditing needs of the Care Management program at Bright Health. Will manage, monitor, and maintain success for all aspects of clinical quality and compliance regarding Chronic/Complex Care Programs, Special Needs Plans Model of Care, and other Care Management programs. This role will ensure all standards and program requirements are understood, implemented, and followed by monitoring/auditing documentation, program outcomes and Care Partner participation. The Quality and Compliance Manager will provide support to management to create needed process improvement, address any quality or compliance concerns and support retraining of staff as needed. In collaboration with the Associate Vice President and the Bright Health Compliance Department, monitor, manage and assist with any CMS or other regulatory agency auditing functions.

ROLE RESPONSIBILITIES
The Quality and Compliance Manager job description is intended to point out major responsibilities within the role, but it is not limited to these items:

1. Serves as the point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory and Health Plan quality of care and service requirements.
2. Lead audit preparation
3. Attends committee meetings as required to provide incoming and outgoing reporting on audit results and corrective action
4. Assist with the development, implementation and monitoring of the health plan, NCQA, URAC, and CMS requirements. The program should include creating systems for peer review, health plan reporting, auditing, guidelines development, disease management, outcome studies, grievance resolution and medical education
5. Maintain passing scores for annual health plan audits and ensure corrective actions, if any, are performed timely and forwarded to health plan representative.
6. Assist with the policy and procedures updates, as necessary.
7. Tracking of Corrective action plans and deliverables
8. Coordinates and gathers documentation to respond to audits conducted either internally or externally
9. Develops tools that assist in determining exposure to clinical quality compliance risks. Identifies opportunities to manage and mitigate those risks.
10. Provides guidance and oversight to business unit audit functions to ensure ongoing clinical quality compliance and monitors corrective action plans relating to quality improvement and compliance.
11. Monitors development and use of metrics for clinical quality compliance.
12. Collaborates with teams across Bright Health on clinical quality compliance initiatives.
13. Collaborate, authors, and provides support to all SNP products including MOC Chapter 4 Development and Management
14. Other duties as assigned

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Requires BS/BA
• RN preferred
• 3 years of experience in Case Management including compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background preferred
• Strong knowledge of Medicare preferred. Healthcare data analysis experience preferred.
• Proficiency with Microsoft Excel, Word, Power Point and Outlook required
• Ability to travel may be required.

LICENSURES AND CERTIFICATIONS
• Active RN license preferred

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
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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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