“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 Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members 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.
- Assessment of the medical, social, and behavioral needs of an assigned population
- Care Plan development and prioritization to transition members to optimal levels of health and self-management.
- Capacity to coordinate 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.
Education, Training, and Professional Experience
- Associate’s degree in Nursing, Bachelor’s degree preferred
- Minimum two (2) years of experience in medical management clinical functions.
- Working knowledge of MCG, InterQual, and NCQA standards
- 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
Licensures & Certifications
- Active and Unrestricted License as a Registered Nurse (RN)
- Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred
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.