Bright Health
Through powerful relationships with care partners, Bright Health aims to help people live healthier and brighter lives
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Manager, Clinical Performance

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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, Clinical Market Performance leads Clinical Market Performance Operations across all Bright Health markets in a Region.  This individual manages a geographically dispersed market-based team of clinical market nurses and clinical consultants.  The Manager, Clinical Market Performance is responsible for establishing and maintaining working relationships with Care Partner (health care provider) clinical leadership and is accountable for the deployment and scaling of clinical operations including quality gaps, risk adjustment, and clinical program governance – based on Care Partner programs. This individual is also ultimately accountable for key clinical results – such as utilization, network keepage, and quality – and for clinical relationship management with care partners and providers for their specific region.

ROLE RESPONSIBILITIES

The Manager, Clinical Market Performance job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Market strategy and execution including but not limited to:

    • Launch and sustain clinical operations in new markets, including establishment of market-specific clinical roadmaps with Care Partners that span the functions of health optimization (population health management, quality, coding performance, accreditation, pharmacy management, and data and analytics).
    • Build an in-depth understanding of internal and external tools and reports available to you and the regional team to orchestrate a coordinated workflow that equally prioritizes the care of the member, Bright Health’s mission, and the care partner.
    • Thoroughly understand and organize market performance operations to effectively design and apply our collective intervention set, meet utilization, keepage, quality and risk targets, monitor and report our performance, and advance and enhance programs.
    • Regularly revise strategy and tactics to address market needs.
    • Launch and sustain clinical operations in markets, including establishment of market specific clinical roadmaps with Care Partners that span the functions of health optimization (pharmacy management, population health management, quality, coding performance, accreditation, and data and analytics)
    • Design and deploy a network optimization approach, in concert with Network and Analytics teams.
    • Work cross functionally to represent the clinical market perspective in design and deployment of non-clinical programs.
  • Guidance on clinical cases and programs including but not limited to:
    • Oversee referral of members to utilization management and care management while providing collaborative support to market team/care partner on strategies to improve these processes.
    • Oversee surveillance of high-risk members, tracking, and trending outcomes of care management/complex care management activities.
  • Quality and risk adjustment management including but not limited to:
    • Support quality and risk process by working with internal teams and collaborating with care partner to request, review, and abstract medical records for HEDIS, quality of care concerns, quality improvement programs, and care coordination, including electronic and paper medical records.
    • Lead STARs/quality improvement efforts in the Region.
  • Management of team including but not limited to:
    • Manage a team of nurses and clinical consultants across geographies. This includes working with nurses to ensure competencies and productivity targets are met and that nurses are working efficiently at the top of their licenses.
  • Care Partner and provider relationship building and management including but not limited to:
    • Engage Care Partners to effectively achieve clinical performance goals using continuous innovation and improvement through dynamic leadership.
    • Build innovative programs through interaction and collaboration with Care Partner clinical leaders, which requires detailed knowledge of health systems, clinically integrated networks, advanced primary care groups, and risk contracts.
    • Convene and lead cross functional teams to mobilize resources within Bright and Care Partners to address issues and to develop processes/relationships.

SUPERVISORY RESPONSIBILITIES

  • This position has responsibility for supervising Clinical Market Performance team members.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in nursing or related field and current license to practice as a nurse required. An advanced degree such as a Master of Business Administration (MBA), Master of Health Administration (MHA), Master of Public Health (MPH), or equivalent degree is preferred.
  • Five (5) years of leadership experience managing care management and quality improvement nurses in payor or provider organizations is required
  • Five (5) years of experience with clinical operations, strategy, services, and/or operations in an integrated delivery system or clinically integrated network is required
  • Experience in some or all the following areas related to value-based care: population health, quality, coding, and health care analytics is preferred
  • Ten (10) years of experience in a managing clinical operations and remote employees is preferred.
  • Ten (10) years of experience consulting or working with clinicians and clinic administrators to transform clinical practices is preferred.

PROFESSIONAL COMPETENCIES

  • Clinical problem solving: technical capability including proficiency within Microsoft office suite.
  • EMR navigation.
  • Analyzing a variety of reports.
  • Relationship building.
  • Understanding population health management methodology.
  • Highly organized and process driven
  • Ability to manage teams across geographical locations
  • Comfortable delivering professional presentations to an audience
  • Exceptional communication skills and will thrive when asked to deliver our unique and differentiated value proposition
  • Proficient in the use of Microsoft Office applications including Outlook, Word, Excel, and PowerPoint
  • Ability to thrive in the fast-paced environment of a rapidly growing organization.
  • Willingness to think creatively and solve problems.

LICENSURES AND CERTIFICATIONS

  • An active, unrestricted Registered Nursing (RN) license in the state of practice is required.

WORK ENVIRONMENT

  • The majority of work responsibilities are performed in an open office and/or home office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.
 
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          
 
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.
 

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What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 2 different health insurance plans, all through BlueCross Blue Shield (HDP & PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We have a Lifestyle Spending Account and options for HSA/FSA. We put 4% of your total earnings into your 401K plan and you are immediately vested. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks. Last Wednesday of every month is reserved for WellBeing Wednesday where we don't schedule any meeting that day so our employees can focus on deep work or learning something new.

Culture
Friends outside of work
Eat lunch together
Intracompany committees
Daily sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Unconscious bias training
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Bright Health employees can contribute up to $3500 annually to their FSA.
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We match 100% on the first 2% and 50% on the next 4%, in other words, if you put in 6% we will add an additional 4%.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Company Equity
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Tuition Reimbursement
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Time allotted for learning
Online course subscriptions available
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

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