Quality Manager at Bright Health

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Quality Manager

Bright Health

| 2023-12-12

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Job details
Company overview

“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

The role of the Quality Manager is to support Quality Improvement through leading assigned Risk Adjustment and HEDIS initiatives throughout the enterprise. The role serves as a key quality of care driver by ensuring provider engagement, ensuring IT capabilities, planning, and prioritizing for the end-to-end for all Quality initiatives. The QM Manager is an operational leader that will ensure implementation of the Neuehealth QM Program.

ROLE RESPONSIBILITIES

Capacity to provide analytical support and synthesize Medicare Risk Adjustment and HEDIS/Quality Measure data and provide interventions for optimization
Develop partnerships with key stakeholders (Quality, Provider Relations, Practice Management, IT etc.) to communicate and implement risk adjustment strategies and HEDIS performance improvement opportunities; to include training/curriculum development
Responsible for implementation of the Quality Initiatives defined by the Quality Improvement Committee; ability to lead QIC meetings when required
Support implementation of the risk adjustment and HEDIS workflows and operating procedures within each market
Responsible for informing key stakeholders of risk adjustment and HEDIS changes and ensures appropriate operational responses to changes.
Lead the clinical documentation improvement efforts; to include, validation of supplemental data for HEDIS and Risk Adjustment
Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned
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. Ability to lift at least 50 pounds.

SUPERVISORY RESPONSIBILITIES

This position may have supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

Bachelor’s degree
Minimum 1 year of experience with Medicare Risk Adjustment coding and HEDIS
Comprehensive knowledge of CMS updates impacting Hierarchical Condition Categories (HCCs), ICD 10 coding, and Medicare/HHS risk adjustment models, NCQA Technical Specifications
Project Management experience, preferred

LICENSURES AND CERTIFICATIONS

Active and unrestricted license as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN), preferred

PROFESSIONAL COMPETENCIES

High Attention to detail and strong analytical skills
High level of critical thinking and problem-solving skills
Strong work ethic and overall positive attitude
Effective communication skills including verbal and written
Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
Demonstrated flexibility, organization, and self-motivation
Highly adaptable to change

PERFORMANCE EVALUATION

Meets Requirements: Evidence the employee performs all functions indicated in the Job Description.
Exceeds Requirements:
Evidence the employee performs all functions indicated in the Job Description AND
Exceeds target for the defined performance metrics AND
Able to identify opportunities to improve AND can communicate in writing an effective performance improvement solution for the team.

BEHAVIORAL AND LEADERSHIP NORMS

Bright Values: Lives the Bright Values. Is focused on bravery needed to develop a variety skills. Not afraid to ask questions or take risks. Focuses on purposeful planning and objective setting. Focuses on the team’s successes, and how to support that effort.
Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented and works on generating input from multiple constituents and driving the team to a solution. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.
Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Works with manager or appropriate liaison in the organization to work through goal setting and milestone development to ensure timely and high-quality work product. Achieves strong results within functional area. Is focused on managing against a predetermined set of objectives, and creates and follows process. Delivers outstanding and sustained results.
Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can drive the business forward and how the bigger picture works. Actively participates in his/her own career development.
Multi-tasking: Balances multiple projects and initiatives at any given time. Alongside manager or appropriate Bright teammate, re-evaluates priorities based on changing company needs to understand what must be done today. Able to balance multiple projects and initiatives at any given time. Capable of deciphering which priorities are most important for the function/organization. Consistently meets deadlines.
Training and Mentoring: Helps train and mentor others: Actively participates in the onboarding and ongoing success of teammates. Onboards, trains and provides informal mentorship to new and existing teammates (interns, consultants, etc.). Provides thoughtful solutions, direction and advice to others, and help advise on priorities.
Upward Management: While balancing multiple initiatives, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.

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.

We’re Making Healthcare Right. Together.

We've won some fun awards like Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our 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!

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