Bright Health
Through powerful relationships with care partners, Bright Health aims to help people live healthier and brighter lives
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Medical Cost Management Consultant at Bright Health (Remote)

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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 Medical Cost Management Consultant is a critical part of the Bright Health Plan Medical Cost team and is responsible for researching, completing detailed analysis, and the successful implementation of results to achieve medical cost savings goals. The position will partner with multiple cross-functional teams and will be accountable to analyze and develop executable initiatives. The Consultant role will own new idea development, market research, business case development, and execution support of assigned initiatives. The Consultant will be responsible for managing opportunities across multiple markets, lines of business (Individual and Family Plans, Medicare Advantage and Employer) and functional areas (Clinical, Network, Operations, etc).

ROLE RESPONSIBILITIES

The Medical Cost Management Clinical Consultant job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Bring together multiple sources of data to design and develop business cases and recommendations that solve medical cost challenges.
    • Partner with analytics resources to define data requirements and analyze results to estimate medical cost impacts.
    • Use data to complete operational impact assessments to identify cost and requirements for implementing recommendations.
    • Produce clear and concise summaries of findings and recommendations for easy consumption by a variety of audiences through a variety of media: presentations, email summaries, executive summaries, and oral discussions.
  • Support execution of approved initiatives to ensure high quality and successful implementations.
  • Investigate key business problems by analyzing data to identify patterns and trends in cost and utilization, translate the analysis into insights, and use the results to define opportunities to drive business action.
  • Complete market and competitive research to drive new ideas to pursue.

SUPERVISORY RESPONSIBILITIES

  • This position does not have supervisor responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s Degree in Computer Science, Economics, Healthcare, or a related field
  • Two (2) or more years of experience in analytical work within the healthcare industry specifically focusing on healthcare claims (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
  • Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vlookups/xlookups and advanced functions/ formulas, creating, using, and interpreting pivot tables, filtering, and formatting.
  • Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
  • Working knowledge in creating and running complex queries using SQL or other programs (i.e. Visual Basic coding, etc.)
  • Experience creating data visualizations with Tableau, MS Power BI or other visualization tool(s).
  • Understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.

PROFESSIONAL COMPETENCIES

  • Previous health plan experience, preferably in one of more of the following areas: Utilization Management, Clinical Innovation, Care Management
  • Knowledge of medical literature evaluation
  • Excellent written and verbal communication skills
  • Ability to perform critical analysis of complex problems and propose appropriate solutions
  • Strong analytical skills, work ethic, problem solving ability, and overall positive attitude
  • Demonstrated flexibility, organization, and self-motivation
  • Adaptable to change

LICENSURES AND CERTIFICATIONS

  • No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

  • 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.
 
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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Technology we use

  • Engineering
  • Product
  • Sales & Marketing
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    • ScalaLanguages
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    • Microsoft DynamicsCRM
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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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