ABOUT THIS ROLE
The Market Clinical Lead, RN will work with Bright’s care partner and will leverage Bright Health’s population health, quality, and risk tools to improve health outcomes for its members. This role is supported by subject matter experts (including other nurses and a medical director) to achieve these goals. This position should have a foundational knowledge of population health management, ability to develop relationships, problem solving skills, and the desire to learn these domains.
- Develop understanding of care partner organization and build relationships to achieve joint clinical operating model.
- Utilize a variety of internal and external tools to orchestrate a coordinated workflow that equally prioritizes the care of the member, Bright Health’s mission, and the care partner.
- Facilitate nomination of members to population health management tools, such as, case management, and chronic care management and provide collaborative support to market team/care partner on strategies to improve these processes.
- Effectively launch market initiatives.
- Provide surveillance of high-risk members, tracking, and trending outcomes of CM/CCM activities as well as quality and risk.
- Assist in HEDIS completion.
- Support quality and risk process by working with internal teams and collaborating with care partner to request, review, and abstract medical records for HEDIS, quality of care concerns, quality improvement programs, and care coordination, including electronic and paper medical records
- Other duties and responsibilities as assigned.
- This position may have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- BSN or MSN in nursing, required.
- Two (2) or more years of hands-on clinical experience or have also worked in managed care.
- Experience or excitement to learn the ins and outs of health plan operations.
- Excellent communication skills and feel comfortable delivering professional presentations to an audience.
- Experience working in a health plan/ payer setting.
- Ability to thrive in the excitement and fast paced environment of a rapidly growing organization.
- Willingness to think creatively and solve problems.
- Clinical problem solving: technical capability including proficiency within Microsoft office suite.
- EMR navigation.
- Analyzing a variety of reports.
- Relationship building.
- Ability to influence without authority.
- Understanding population health management methodology.
LICENSURES AND CERTIFICATIONS
- Current and active RN license is required for this position.
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.
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.
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
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.