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
As the Regional Medical Director for the West Region, you will be a clinical support to our unique care partner integration programs. You will support nurses and market leaders in managing utilization, quality and risk adjustment-related objectives in a manner that integrates with our care partners care coordination models. You will be responsible for providing clinical expertise and direction to support medical management and pharmacy programs. You will deeply collaborate with the Market and Clinical Teams at Bright Health and will inform our regional clinical strategy. You will have extensive interactions with our Care Partner’s Executive Team and Physician Leadership, and physician networks, in presenting plan performance, educating providers on Bright’s model and outcome objectives, and managing toward jointly held outcomes goals.
Provides medical leadership for utilization management, cost containment, and clinical quality improvement activities
Provides oversight and peer to peer communication in support of concurrent review of inpatient care and post-acute care, and support to chronic condition plans
Collaborates with regional nurses and analysts to formulate and implement plans to address patterns of over- and under-utilization, and improve HEDIS and risk adjustment metrics
Facilitates planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
Supports practice improvement efforts and education efforts with regional providers
Collaborates with practice leadership for Bright owned practices and communicates utilization outcomes and quality and risk metrics
Supports and delivers clinical performance metrics to executive and clinical leadership teams with regional care partners and works toward continuous performance improvement
Concurrent review, transition of care planning, high utilizer rounds with nurses
Support peer to peer conversations for authorization, appeal and concurrent review
Participate in reviews of utilization, quality and risk by line of business and market
Support implementation and joint operating committees with care partner health systems
Outreach and educate providers on performance and incentives for utilization, quality and risk
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
Medical Doctor or Doctor of Osteopathy required
Active, unrestricted license to practice medicine in the state of Texas required. Licensure in Arizona preferred.
Board certification in Internal Medicine, Family Practice or other primary care specialty preferred; Other specialties will be considered if experience is aligned to objectives
LICENSURES AND CERTIFICATIONS
Active, unrestricted license to practice medicine in Texas is required
This position requires strong communication skills, with a minimum of five (5) years’ experience in clinical practice. Administrative or managed care experience is highly desirable
This position requires strong interpersonal skills to generate collaboration and enable independent decision making amongst internal and external clinical staff
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.