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
- Supports the claims operations team with select clinical claim activities for those individuals interested in medical coding and claims payment.
- Collaborates with BHG market leadership to improve market performance, align incentives, and support practice improvement efforts and education efforts with regional providers
- 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
- Periodically supports in-person presentations of corporate initiatives, clinical performance metrics, and value based care action plans to regional Care Partner executive and clinical leadership teams in collaboration with other CMP staff and regional leadership.
- Provides support and leadership for utilization management, cost containment, and clinical quality improvement activities, including medical necessity review of select outpatient, inpatient, and post-acute care services.
- Supports case management nurses as require individual care plans and other interdisciplinary care team activities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Medical Doctor or Doctor of Osteopathy.
- Board certification in a medical specialty, or general surgery preferred.
- Other specialties will be considered if experience is aligned to objectives
- Active, unrestricted license to practice medicine in a state or territory of the United States.
- Willing to acquire additional medical licenses with company support.
- Licensure in Colorado, Arizona or Texas preferred
- This position requires strong communication skills, with a minimum of five years experience 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.
BEHAVIORAL AND LEADERSHIP NORMS
- Bright Values: Lives the Bright Values. Leads by example. Is viewed as an emerging leader in the company. Acts with quiet, calm determination. Effectively influences inside of the organization.
- Decision making: Drives strong decision making at a functional level. Is capable of taking a large sum of information, and drilling into what is important. Understands organizational impact of decisions and communicates effectively throughout the decision-making process. Pushes issues to resolution.
- Delivers Results: Is results oriented. Is capable of deciphering priorities for self and for others, and focuses the group on what must be done today, and who must do what. Is capable of clearly translating strategic objectives into implementable processes that drive outcomes. Focuses on results, not effort, and is able to efficiently direct time and energy to achieving intended outcome. Can successfully develop a budget and achieve it without sacrificing quality of output. Achieves strong results within their functional area. Has an excellent track record of achieving expected results. Understands how to operate in collaborative framework.
- Direct and Indirect Management: Demonstrates leadership skills. Has mastered autonomous work, and is able to successfully influence direct and indirect teams to achieve goals. Organizes people and resources toward the effective and pursuit of objectives: this includes hiring, firing, efficient supervising and performance appraisals. Delivers thoughtful and constructive feedback to teams, and actively works to develop those around them. Sets an example for our employees. Manages up appropriately and knows how and when to escalate an issue or situation to more senior manager.
- Planning and Execution: Identifies need for planning and has skills to develop, implement, monitor and achieve plans. Knows how and when to adjust plan. Leads others in this effort. Hold self and team accountable for effective planning and execution. Overcomes hurdles.
- Presence: Internally, leads large and small groups of people in meetings. Capable of developing thoughtful agenda, setting objectives, driving clarity of purpose and delivering the intended results. Instills confidence.
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.
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.