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.
SCOPE OF ROLE
Bright Health Group is building the future of integrated healthcare by advancing its alignment model across the U.S.
This advancement brings an elevated level of complexity and it is paramount that Bright Health Group is compliant with the letter and spirit of accrediting and regulatory body requirements and recommendations.
Developing and maintaining a clinical excellence program ensures high quality care and services are provided to the consumer with every clinical interaction.
This role is accountable for enabling, leading, and extending enterprise health affairs.
ROLE RESPONSIBILITIES
Support and oversee clinical accreditation and quality activities across the Bright Health Group enterprise.
In partnership with the key quality leaders at business and functional units across Bright Health Group and its partners, Articulate the Bright Health Clinical Excellence framework, including clinical quality program, structure, and operating standards for each line of business (including but not limited to Group, Medicare Advantage, Medicaid, and Individual and Family Plans); Ensure high levels of clinical excellence through the appropriate oversight actions (e.g., mock audits, risk and control reporting, review of remediation and corrective action plans) Act as the executive liaison for regulatory and accrediting agencies in conjunction with the Compliance and Regulatory Affairs team; Build and maintain a library of policies, programs, measurements, and other resources that can be leveraged broadly across all parts of the organization; Assimilate and share quality and accreditation standards (current and expected changes) at the national, state, and local levels; Chair the Bright Health & Wellbeing Council, into which the regional Quality Management Committees report Define, populate, and publish a quality and Bright Health clinical excellence performance scorecard on a quarterly basis.
This summative report establishes clear visibility to clinical performance across the organization.
In partnership with business unit clinical and pharmacy leaders, establish and maintain a library of effective healthcare, pharmacy, and medical policies for adoption and use across the Bright Health enterprise Define all key use cases for medical policy across lines of business, functional areas, and business units; Review and approve appropriate enterprise-wide control environment, review, sign-off, and distribution mechanisms; Oversee and approve appropriate variability in medical policies across the enterprise; Work with appropriate external entities (e.g., ICER, AHIP, Milliman, Interqual) to establish an evergreen body of medical evidence and the value of related clinical interventions; Consistently scan the medical industry, regulatory bodies, and public entity policies to anticipate needs for new medical policy or policy adjustments; Actively identify and prioritize gaps in the body of medical policy to ensure appropriate closure.
In partnership with the legal team, subject matter experts, and clinical experts, build a library of clinically related healthcare policy positions that can be used to guide medical policy, and clinical and business strategies Establish domains of interest to the business (e.g., COVID-19, Social Determinants of Health) Build healthcare policy positions including socialization, sign-off, publishing, and distribution methods.
Advance the articulation of the Bright Health Aligned Model of Health framework Inform the evolution of the care model by establishing a roadmap of high value interventions, engagement methods, and analytic insight in concert with the Health Intelligence Team, Bright HealthCare and other Bright Health plans, and NeueHealth; Represent the organization’s aligned model of health externally with thought leaders, vendors, partners, and other stakeholders; Ensure alignment with the VP of Clinical Affairs and the VP of Enterprise Clinical Excellence.
In partnership with Human Capital leadership, advance and oversee the programs to foster clinical leadership.
This includes Fostering a culture of clinical leadership Clinical leadership development Other duties and responsibilities as assigned.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
Twelve (12) or more years of clinical, quality improvement, and management experience, including at least three to five (3-5) years of health plan medical management and health care analytics experience required.
Advanced clinical degree such as RN, PharmD, DO, MD or equivalent advanced degree required In-depth knowledge of healthcare management, managed care, and population health required.
Experience working with and collaborating successfully with executive clinical and business leadership; experience in preparing and presenting information to clinical and executive level leadership required.
Experience working in an organization with national scope Experience with multiple lines of business (e.g., Medicare Advantage) Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required.
Experience with systems and process design/implementation/evaluation required.
Adept at using data and analytics advance programmatic design required.
Experience evaluating and modifying programmatic approaches to clinical and quality management required.
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.
PROFESSIONAL COMPETENCIES
Ability to work independently, handle multiple assignments and prioritize workload Advanced ability as a licensed professional to communicate on any level required to meet the demands of the position using lines of authority appropriately Highly developed strategic, critical thinking, problem-solving, and organizational skills Highly capably communicator with individuals and groups (verbal, writing, and presentation) with the ability to project a clear and authoritative clinical and quality compliance voice Familiarity with NCQA, URAC, Joint Commission and other accreditation bodies and process standards, as well as clinical and quality requirements for other regulatory agencies Proficient with Microsoft Office Skills with Word, Excel, Outlook and PowerPoint
We’re Making Healthcare Right.
Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team.
By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve.
We do this by:
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
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.
Have you previously been employed by Bright Health?
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Do you have an existing employment agreement (i.e.
non-compete)?
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Are you or your close relative currently employed by Deloitte?
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Will you now, or in the future, require visa sponsorship?
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U.S.
Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Bright Health are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation.
You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
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