Quality 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.
- Capacity to provide analytical support and synthesize Medicare Risk Adjustment and HEDIS/Quality Measure data and provide interventions for optimization
- Develop partnerships with key stakeholders (Quality, Provider Relations, Practice Management, IT etc.) to communicate and implement risk adjustment strategies and HEDIS performance improvement opportunities; to include training/curriculum development
- Responsible for implementation of the Quality Initiatives defined by the Quality Improvement Committee; ability to lead QIC meetings when required
- Support implementation of the risk adjustment and HEDIS workflows and operating procedures within each market
- Responsible for informing key stakeholders of risk adjustment and HEDIS changes and ensures appropriate operational responses to changes.
- Lead the clinical documentation improvement efforts; to include, validation of supplemental data for HEDIS and Risk Adjustment
- Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned
- 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. Ability to lift at least 50 pounds.
- This position may have supervisory responsibilities.
- Bachelor’s degree
- Minimum 1 year of experience with Medicare Risk Adjustment coding and HEDIS
- Comprehensive knowledge of CMS updates impacting Hierarchical Condition Categories (HCCs), ICD 10 coding, and Medicare/HHS risk adjustment models, NCQA Technical Specifications
- Project Management experience, preferred
- Active and unrestricted license as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN), preferred
- High Attention to detail and strong analytical skills
- High level of critical thinking and problem-solving skills
- Strong work ethic and overall positive attitude
- Effective communication skills including verbal and written
- Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
- Demonstrated flexibility, organization, and self-motivation
- Highly adaptable to change
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.