Bright Health Group
“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.
ABOUT THE ROLE
As the Regional Medical Director for the West Region, you will be a clinical support to our unique care partner integration programs. You will support nurses and market leaders in managing utilization, quality and risk adjustment-related objectives in a manner that integrates with our care partners care coordination models. You will be responsible for providing clinical expertise and direction to support medical management and pharmacy programs. You will deeply collaborate with the Market and Clinical Teams at Bright Health and will inform our regional clinical strategy. You will have extensive interactions with our Care Partner’s Executive Team and Physician Leadership, and physician networks, in presenting plan performance, educating providers on Bright’s model and outcome objectives, and managing toward jointly held outcomes goals.
- Provides medical leadership for utilization management, cost containment, and clinical quality improvement activities
- Provides oversight and peer to peer communication in support of concurrent review of inpatient care and post-acute care, and support to chronic condition plans
- Collaborates with regional nurses and analysts to formulate and implement plans to address patterns of over- and under-utilization, and improve HEDIS and risk adjustment metrics
- Facilitates planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members
- Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
- Supports practice improvement efforts and education efforts with regional providers
- Collaborates with practice leadership for Bright owned practices and communicates utilization outcomes and quality and risk metrics
- Supports and delivers clinical performance metrics to executive and clinical leadership teams with regional care partners and works toward continuous performance improvement
- Concurrent review, transition of care planning, high utilizer rounds with nurses
- Support peer to peer conversations for authorization, appeal and concurrent review
- Participate in reviews of utilization, quality and risk by line of business and market
- Support implementation and joint operating committees with care partner health systems
- Outreach and educate providers on performance and incentives for utilization, quality and risk
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Medical Doctor or Doctor of Osteopathy required
- Board certification in Internal Medicine, Family Practice or other primary care specialty preferred; Other specialties will be considered if experience is aligned to objectives
- Active, unrestricted license to practice medicine in a state or territory of the United States. Licensure in Colorado, Arizona or Texas preferred
- This position requires strong communication skills, with a minimum of five (5) years’ experience in clinical practice. Administrative or managed care experience is highly desirable
- This position requires strong interpersonal skills to generate collaboration and enable independent decision making amongst internal and external clinical staff
LICENSURES AND CERTIFICATIONS
- Active, unrestricted license to practice medicine in a state or territory of the United States is required
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.