“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
Bright Health’s Case Management team supports plan members that are impacted by significant health and/or lifestyle events, situations or conditions. Clinical Case Managers assist Bright members by coordinating care across multiple clinical providers, assist with establishing social support services, and/or providing education for self-care and monitoring practices. These services are guided by established policies and procedures, developed by Bright’s Clinical Programs team. This role embodies a philosophy that maintains focus on improving members’ health and supporting a positive service experience. The Case Manager will ensure all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
- Work with members, their providers and applicable care teams to develop personal care plans associated with medical, behavioral and/or social situations
- Conduct outbound interventions to advance member care plans, coordinate care and close clinical gaps
- Collaborate with Provider Relations, Market Management teams and Care Partner representatives in the management of members’ care plans
- Participate in the development of operating models to execute clinical program solutions, including but not limited to Complex Case Management, Disease Management and Transitions of Care
- Collaborate with organizational leaders, including, but not limited to Network Navigation, Product, Clinical Program Management and Market Performance to identify opportunities for service improvement, including further integration with Bright’s Care Partners where appropriate
- Provide feedback to Program Management team with respect to program design, efficiency, efficacy and member/provider satisfaction
- Support the development and maintenance of standard operating procedures related to corresponding clinical program functions
- Participate in, and/or lead the implementation of new care coordination initiatives and/or new market installations
- Manage individual workplan and prioritize time to meet key deliverables
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s Degree in a related field required
- Three (3) or more years of clinical or case management experience preferred
- Prior experience with URAC accreditation preferred, but not required
- Must be Bilingual in Spanish
- Ability to evaluate complicated problems and isolate contributing factors
- Capable communicator that can interact with others at multiple levels within the organization
- Leads through influence and example
- Strong operational mindset and use data to draw insights
- Thrives on driving results in a collaborative environment
LICENSURES AND CERTIFICATIONS
- An active, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) license 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.