Bright Health is delivering a smarter, more connected healthcare experience. Our affordable health insurance plans and exclusive partnerships with leading health systems are reshaping how people and physicians achieve better health. Today, Bright Health provides health insurance to individuals in Colorado, Arizona, and Alabama in both the Individual and Medicare Advantage space.
Come join our mission: Making Healthcare Right. Together!
As the Market Clinical Lead RN, you will work with Bright Health'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. To be successful, you should have a foundation of knowledge in population health management, ability to develop relationships, and problem solving skills.
YOU CAN ANTICIPATE YOU WILL
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
Ability to thrive in the excitement and fast paced environment of a rapidly growing organization.
Willingness to think creatively and solve problems.
Current and active RN license, required.
BSN or MSN in nursing, required.
You have 2+ years of hands-on clinical experience or have also worked in managed care.
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.
Clinical problem solving: technical capability including proficiency within Microsoft office suite
Analyzing a variety of reports
Ability to influence without authority
Understanding population health management methodology
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!