Clinical Operations Specialist, RN
Bright Health, Birmingham, AL
WE’RE NEW, BUT WE’RE NOT NEW AT THIS.
- Develop understanding of care partner organization and build relationships to achieve joint clinical operating model.
- Utilize a variety of internal and external tools to orchestrate a coordinated workflow that equally prioritizes the care of the member, Bright Health’s mission, and the care partner.
- Facilitate nomination of members to population health management tools, such as, case management, and chronic care management and provide collaborative support to market team/care partner on strategies to improve these processes.
- Effectively launch market initiatives.
- Provide surveillance of high-risk members, tracking, and trending outcomes of CM/CCM activities as well as quality and risk.
- Assist in HEDIS completion.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- BSN or MSN in nursing, required.
- Two or more (2+) years of hands-on clinical experience or have also worked in managed care.
- Experience or excitement to learn the ins and outs of health plan operations.
- Excellent communication skills and feel comfortable delivering professional presentations to an audience.
- Experience working in a health plan/ payer setting.
- Clinical problem solving: technical capability including proficiency within Microsoft office suite.
- EMR navigation.
- Analyzing a variety of reports.
- Relationship building.
- Ability to influence without authority.
- Understanding population health management methodology.
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.
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