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
The Clinical Market Performance Lead Nurse will work with Bright’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. This position should have a foundational knowledge of population health management, ability to develop relationships, problem solving skills, and the desire to learn these domains.
- The Clinical Market Performance Lead Nurse job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Provide surveillance of high-risk members, tracking, and trending outcomes of CM/CCM activities as well as quality and risk.
- Develop understanding of care partner organization and build relationships to achieve our joint clinical operating model with local provider groups.
- 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.
- 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.
- Other duties and responsibilities as assigned.
- This position does not have supervisory responsibilities.
- 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. Travel may be required.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- BSN or MSN in nursing, required.
- Two (2) years of hands-on clinical experience or have also worked in managed care required.
- Experience or excitement to learn the ins and outs of health plan operations required.
- Excellent communication skills and feel comfortable delivering professional presentations to an audience required.
- Experience working in a health plan/ payer setting required.
- Bilingual, Spanish/English fluency required
- Clinical problem solving: technical capability including proficiency within Microsoft office suite
- EMR navigation
- Analyzing a variety of reports
- Relationship building
LICENSURES AND CERTIFICATIONS
- An active, unrestricted Registered Nursing (RN) to practice as a health professional in the state of Florida is required for this role.
Bright Health is committed to following the federal government guidelines for vaccination requirements, ensuring the safety of our employees, and helping protect the people we serve. Certain positions, including this position, require full vaccination against COVID-19 (including any booster shots if required), where allowable under the law, unless approved for a reasonable accommodation based on a medical condition or religious belief.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.