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!
SCOPE OF ROLE
As the Regional Clinical Lead, RN you will support and oversee the market operations functions in your specified region, not only as a leader, but also as a doer. In this role, you will blend your expert understanding of Bright Health's market operations tools, the care partner relationship and capabilities, and member needs to lead the team to achieve results. This includes understanding process and performance metrics and reporting achievements and outcomes of the region to the in-market health optimization team leadership.
YOU CAN ANTICIPATE YOU WILL:
Develop understanding of care partner organizations in your region and build relationships to achieve joint clinical operating model.
Build and in-depth understanding of internal and external tools and reports available to you and the regional team to orchestrate a coordinated workflow that equally prioritizes the care of the member, Bright Health's mission, and the care partner.
Oversee nomination of 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.
Effectively launch market initiatives.
Oversee surveillance of high-risk members, tracking, and trending outcomes of CM/CCM activities
Deploy market activities in your region to achieve Bright Health's strategy for quality and risk; network boundary management; and utilization.
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.
Develop in-depth understanding of key performance metrics and status of each market. Ability to compile and present information to Bright Health leadership.
Five or more (5+) years of management experience in a healthcare setting, required; experience in managed care, preferred.
Experienced or excitement to learn the in's and out's 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 travel within your region to meet with the market operations team and the care partner.
Ability to thrive in the excitement and fast paced environment of a rapidly growing organization.
Willingness to think creatively and solve problems.
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
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!