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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 role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum.
- Capacity to collect relevant clinical data to support the care planning process
- Care Plan support, intervention, and prioritization to transition members to optimal levels of health and self-management.
- Capacity to participate in interdisciplinary team meetings as required
- Collaboration across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
- Provide transition of care interventions as required
- Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
- Facilitate linkage to appropriate community resources to address social determinants of health
- Capacity to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
- Able to ensure member communication and notices are composed in a manner consistent with regulatory standards.
- Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.
- This position does not have supervisory responsibilities.
- 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.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Associate’s degree in Nursing, preferred
- Minimum 2 years of experience in medical management clinical functions.
- Working knowledge of MCG, InterQual, and NCQA standards
LICENSURES AND CERTIFICATIONS
- Active and Unrestricted License as a Licensed Vocational Nurse (LVN)
- Certification Managed Care Nursing (CMCN) preferred
- 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
- 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.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.