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 Manager of Care Coordination will lead the program design and policy development of Bright Health’s clinical programs with a primary focus on care coordination strategy. Care coordination initiatives may include case management, disease management, and effectively transitioning to a new care setting. This position will provide leadership to cross functional work teams and provide core clinical and programmatic subject matter expertise. The Manager of Care Coordination will be responsible for the definition, documentation and maintenance of associated clinical program objectives and policies. This role will have accountability for the oversight of both internal and delegated care coordination program operations. This role will participate in workflow development and applicable configuration within the care management platform. The Manager of Care Coordination will ensure all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
The Manager, Care Coordination job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Supports the strategic vision and manages the corresponding design for Bright’s care coordination programs. (e.g., case management, disease management and transitions of care)
- Manages the implementation of care coordination programs, including the development of policies, workflows, and quality improvement processes.
- Collaborates with both internal and external stakeholders (e.g., Provider Relations, Market
- Management teams, and Care Partner representatives) to support care coordination programs.
- Facilitates cross functional workgroups in the ongoing review and management of program
- Provide quality assurance and analysis of care coordination programs design, efficacy, efficiency, and member/provider satisfaction as well as development of work plans to address performance improvement opportunities.
- Initiate program improvement projects and activities to drive outcomes for members enrolled and
engaged in the care coordination programs.
- Collaborate with organizational leaders, including, but not limited to Network Navigation, Product, Clinical Operations, and Market Performance to identify opportunities for improvements to care coordination programs.
- Ensures methods are in place to consistently measure and evaluate program performance metrics, sharing observations with internal and external stakeholders.
- Provide subject matter expertise at internal clinical and quality meetings, regulatory meetings, and any relevant community partner meetings, workgroups, etc.
- Participate in the development of additional population health strategies including (e.g., chronic
condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)
- Provide business requirements to support program configuration within the care management
- Adapts care coordination policies, workflows, and priorities to address business and operational
- Other duties and responsibilities as assigned
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- A Bachelor’s degree is required; relevant experience of five (5) or more years of experience will be considered in lieu of a degree.
- Prior experience with State and Federal regulatory and accreditation requirements is required
- Four (4) years of experience with improving clinical quality, health care analytics, or driving clinical transformation initiatives with population health program in a Managed Care setting is highly preferred
- Experience in interpreting data analytics, outcomes measures in health care and use of that data to drive change is preferred.
- Ability to evaluate complicated problems and isolate contributing factors and develop solutions.
- Leads through influence and example
- Good communication skills oral and written and are able to interact with others at multiple levels of the organization.
- Ability to develop strong cross-functional and collaborative relationship with internal and external partners, including the ability to work with a wide variety of people and personalities.
- Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative environment.
- Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.
LICENSURES AND CERTIFICATIONS
- An active, unrestricted Registered Nursing (RN), Licensed Practical Nurse (LPN), Licensed Social Worker (LICSW) or Licensed Professional Clinical Counselor (LPCC) license to practice as a health professional in a state or territory of the United States is required for this role.
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.
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.