Uncubed
           

Quality and Risk Medical Director - Medicare Advantage

Bright Health, Minneapolis, MN

WE’RE NEW, BUT WE’RE NOT NEW AT THIS.


ABOUT THIS JOB

As the Medical Director of Quality and Risk, you will provide Clinical Support to our Quality and Risk Directors, and to the Medicare Advantage product.  You will be responsible for developing clinical programs to support Quality Improvement plans, capture of quality metrics both preventive and disease specific, complete and accurate risk documentation, and work with our exclusive care partners in each market to attain those goals.   You will be responsible for providing clinical expertise and business direction to support Medicare Advantage product teams through care management and pharmacy programs. You will deeply collaborate with the Health Optimization Team at Bright Health and will inform our corporate clinical strategy.  You will have extensive interactions with our Care Partner’s Clinical Leadership, in presenting plan performance, and managing toward jointly held outcomes goals in Quality and Risk. 

YOUR RESPONSIBILITIES

  • Work to achieve the Quality and Risk performance objectives for each market (quality, risk, compliance and consumer experience) within the constraints of the benefit design, bid, and network configuration
  • Operationalize clinical programs and educate providers across our Medicare Advantage and SNP products in all markets in concert with care partners
  • Actively participate in, and work toward metrics in these domains:
  • Quality: CCIPS Implementation, STARS Optimization
  • Clinical Compliance: Appeals & Grievances, FWA monitoring, Compliance reporting
  • Advanced Delivery Models components, including physician incentives for quality
  • Risk Adjustment:  complete and accurate coding
  • Clinical problem solving with market staff
  • Provide clinical expertise and business direction in support of clinical programs through participation in clinical team activities: P&T Committee, Quality Committees, Credentialing Committees, Market and Product meetings, and Joint Operating Committees
  • Promote approaches that can improve clinical practice performance while achieving similar or greater clinical quality
  • Develop, maintain and assure compliance with physician review policies and procedures (including timeliness) for Appeals & Grievances, Quality of Care reviews, and support case management
  • Support Provider Education efforts

ABOUT YOU

  • 3+ years’ experience in Clinical Practice and the Health Care Industry
  • 3+ years’ experience and leadership in Medicare Advantage health plan products
  • Strong understanding of CMS rules and guidelines preferred
  • You have post-graduate experience in direct patient care
  • Previous leadership experience in a clinical oversight role
  • MD or DO Board Certification
  • Unrestricted License
  • MPH/MHA/MBA or 3+ years’ experience in payer environment
  • In addition to the above experience, we want you to be deeply motivated to join an organization that places relationships at the center of better healthcare delivery. Like others on our team, you are humble, mature, and check your ego at the door. You are brave and always challenge the status quo, but respectful and have an open mind. You are excited to take ownership at an early stage of our company. 


ABOUT US
 
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.
 
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
 
We’re Making Healthcare Right. Together. 

We've won some fun awards like: Great Places to WorkModern HealthcareForbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!
 
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.

BRIGHT ON!

About Bright Health

Here’s the great thing about building a health plan from the ground up. We get to ask "why" at every turn – and make every decision a thoughtful one. But we’re different than other new health insurance companies because we come from big places. Our leaders have decades of experience working in health insurance and are committed to improving the customer experience. They started Bright Health because they know what to do and, more importantly, what not to do when creating a system that will actually work in your favor. Bright Health believes healthcare can be done better. Our carefully selected network: When we sat down to design Bright Health plans, we were thinking about relationships – the one between you and your doctor, and also the one between us and your doctor. Then we set out to create purposeful partnerships with caring providers. We call them our Care Partner. Our tight-knit network gives you access to a community of compassionate providers who are working together with us and with each other to help you live Brighter. Our commitment to service: When you need care, you want someone familiar who can help you, someone who actually feels good to interact with. And in-between visits to the doctor, you want someone who will help you thrive. So with any Bright Health plan, you get us, your Bright Health Team. We’re here, ready to help. No matter if your question is “Can I see this doctor?” or “How much is covered?” it’s easy to reach a real person who can get you the right answers and help you find the right care. There, that’s better. Our Whole Health Rewards: Keeping good health extends far beyond how many steps you take, what your BMI is, or what kind of food you eat. Don’t get us wrong, those things certainly contribute to your well-being but there’s a whole lot more to the picture. We provide opportunities for you to earn $$ throughout the year for making good decisions that lead to a Brighter life. When you and your health plan both want what’s best for you – it makes staying well a whole lot easier.

Want to learn more about Bright Health? Visit Bright Health's website.