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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.


 

The Sr. Quality RN is a member of the clinical market performance team and is responsible for on the ground support of STARs, HEDIS, and risk adjustment programs in the market. The role’s primary focus is building relationships with practices with the goal of conducting concurrent chart review to improve practice performance across the Sr. Quality RN’s key support areas.   In certain scenarios, the RN may also be tapped to engage telephonically or in-person with certain high risk members. As a member of the in-market clinical team, it will be the RN’s responsibility to understand the responsibility to understand the organizational make-up of their market, learn programmatic capabilities of the health plan, and work within these structures to effectively deliver results within the scope of their work

ROLE RESPONSIBILITIES

  • Build and maintain relationships with providers, clinic staff, and clinic leadership to facilitate effective Bright Health quality and risk activities
  • Build and implement strategies to facilitate quality/risk gap closure with care partners
  • Analyze HEDIS data and identify trends to develop targeted recommendations for providers, clinics, and care partners to enhance member care
  • Leverage clinical knowledge to review medical records in order close HEDIS/risk gaps
  • Educate providers on HEDIS/risk adjustment best practices to enhance member care
  • Deploy and monitor performance of Bright providers as well as member incentive programs
  • Where applicable, lead a team of quality specialists supporting STARs, quality, and risk activities
  • Collaborate with cross functional teams to enhance Bright’s STARs, quality, and risk activities
  • Create and establish standardized processes for HEDIS gap closure

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • BSN and active RN license.
  • Three (3) or more years of experience with a health plan working on a quality and/or risk team.
  • Detailed understanding of STARs, with experience working on CAHPs, HOS, and HEDIS
  • Basic knowledge of ICD-10 coding related to risk adjustment.
  • Excellent project management communication and written skills
  • Organized and able to meet tight deadlines.
  • Works well on a team and possesses good interpersonal skills.

PROFESSIONAL COMPETENCIES

  • Excellent customer service and phone presence
  • Comfortable navigating EHRs to identify clinical documentation
  • Expert understanding of HEDIS measures and clinical documentation for compliance.
  • Knowledge of clinical programs and P&P, HIPAA regulations and guidelines, American Disability Act, URAC standards, and clinical ethics.
  • Experience with risk adjustment coding with a certified risk adjustment coder preferred but not required.
  • Experience working with health care systems and health plans.
  • Analytical and problems-solving skills
  • Advanced skills in Microsoft product suite, including Excel, Visio and PowerPoint

LICENSURES AND CERTIFICATIONS
• An active, unrestricted Registered Nursing (RN) to practice as a health professional in the state of AZ is required for this role

WORK ENVIRONMENT

  • Most of work responsibilities are performed in an open office setting, at home, or from a provider’s office. Some travel outside the market of support may be required, but >80% will occur within the market

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 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.
 

 

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