Clinical Case Manager at Bright Health
- 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 work-plan 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
- 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), or Licensed Clinical Social Worker (LCSW) license is required.