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.
This role leads Clinical Market Performance Operations across all Bright Health markets in Texas. This individual manages a geographically dispersed market-based team of regional and local clinical market nurses, clinical consultants, and quality nurses. The Director, Clinical Market Performance is responsible for establishing and maintaining working relationships with Care Partner (health care provider) clinical leadership and is accountable for the deployment and scaling of clinical operations including quality gaps, risk adjustment, and clinical program governance – based on Care Partner programs. This individual is also accountable for key results, such as utilization, network keepage, accurate risk adjustment, and quality. In addition to market duties, this role has oversight over utilization management, training, and clinical competencies for all clinical roles in the Clinical Market Performance team.
ROLE RESPONSIBILITIES The responsibilities of the Director, Clinical Market Performance include but are not limited to:
1. Market strategy and execution • Thoroughly understand and organize market performance operations to effectively design and apply our collective intervention set, meet utilization, keepage, quality and risk targets, monitor and report our performance, and advance and enhance programs. • Build innovative programs through interaction and collaboration with Care Partner clinical leaders, which requires detailed knowledge of health systems, clinically integrated networks, advanced primary care groups, and risk contracts. • Launch and sustain clinical operations in new markets, including establishment of market-specific clinical roadmaps with Care Partners that span the functions of health optimization (population health management, quality, coding performance, accreditation, pharmacy management, and data and analytics). • Build an 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. • Design and deploy a network optimization approach, in concert with Network and Analytics teams. • Work cross functionally to represent the clinical market perspective in design and deployment of non-clinical programs. • Regularly revise strategy and tactics to address market needs. 2. Guidance on clinical cases and programs • Oversee surveillance of high-risk members, tracking, and trending outcomes of care management/complex care management (CM/CCM) activities.
3. Quality and risk adjustment management • 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. • Lead STARs/quality improvement efforts in the Region. 4. Care Partner relationship building and management • Engage Care Partners to effectively achieve clinical performance goals using continuous innovation and improvement through dynamic leadership. • Convene and lead cross functional teams to mobilize resources within Bright and Care Partners to address issues and to develop processes/relationships.
5. Management of team • Manage a team of nurses and clinical consultants (analysts) across geographies. This includes working with nurses to ensure competencies and productivity targets are met and that nurses are working efficiently at the top of their licenses.
SUPERVISORY RESPONSIBILITIES This position has responsibility for supervising a team of nurses and clinical consultants.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE • Bachelor’s degree in nursing or related field and current license to practice as a nurse • An advanced degree such as a Master of Business Administration (MBA), Master of Health Administration (MHA), Master of Public Health (MPH), or equivalent degree is preferred. • Seven (7) or more years of leadership experience managing care management and quality improvement nurses in payor or provider organizations is required • Seven (7) or more years of experience with clinical operations, strategy, services, and/or operations in an integrated delivery system or clinically integrated network is required • Experience in value-based care, population health, quality, coding, training, utilization management, and/or health care analytics is required
PROFESSIONAL COMPETENCIES • Highly organized and process driven • Ability to manage teams across geographical locations • Comfortable delivering professional presentations to an audience • Exceptional communication skills and will thrive when asked to deliver our unique and differentiated value proposition • Proficient in the use of Microsoft Office applications including Outlook, Word, Excel, and PowerPoint
LICENSURES AND CERTIFICATIONS
Current license to practice as a nurse in the state of Texas is required.
Most work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Videoconferencing is used frequently. Travel is required.
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.
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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.