The Market Clinical Lead, RN will support and oversee the market operations functions across regions as needed, not only as a leader, but also as a doer. In this role, the lead will blend their expert understanding of Bright Health’s market operations tools, the care partner relationship and capabilities, and member needs to support clinical operations and achieve results. This includes understanding process and performance metrics and reporting achievements and outcomes to the in-market health optimization team leadership.
- Leverage understanding of care partners organizations and relationships to achieve joint clinical operating model, including support for existing CPs that are adding a line of business or taking on higher level of integrated responsibilities.
- Build an in-depth understanding of internal and external tools and reports available to the team and support markets with training, interpretation, and actions related to findings.
- Facilitate quality, risk, and STAR initiatives.
- In-depth understanding of population health management functions and ability to do the following:
- Nominate members to utilization management, case management, and chronic care management and provide collaborative support to market team/care partner on strategies to improve these processes.
- Oversee surveillance of high-risk members, tracking, and trending outcomes of CM/CCM activities.
- Deploy market activities to achieve Bright Health’s strategy for quality and risk; network boundary management; and utilization.
- Problem solve utilization and network keepage issues by deploying member interventions to achieve annual targets.
- Build relationships with Care Partner and work with key contacts to do member outreach, problem-solve network keepage and utilization issues.
- Support quality and risk process by working with internal teams and collaborating with care partner to request, review, and abstract medical records for HEDIS, care gap closure, quality of care concerns, quality improvement programs, and care coordination, including electronic and paper medical records.
- Ability to thrive in the excitement and fast paced environment of a rapidly growing organization.
- Willingness to think creatively and solve problems.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- BSN or MSN
- 5+ years of leadership experience in a healthcare setting.
- Experience in managed care a plus.
- You are able to travel within your region to meet with the market operations team and the care partner.
- You've experienced or are excited to learn the ins and outs of health plan operations
- You have excellent communication skills and feel comfortable delivering professional presentations to an audience.
- You have experience working in a health plan/ payer setting.
- In-depth understanding of population health management methodology
- Team leadership experience;
- Clinical problem solving;
- Technical capability including proficiency within Microsoft office suite and using EMRs;
- Retrieving, sorting, and navigating a variety of reports;
- Relationship building;
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.