“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 Director, Case Management will collaborate with clinical leaders to build and implement solutions that align with Bright’s overall clinical management strategy and deliver excellent compliance and medical cost results in alignment with Bright Health’s Care Partner strategic approach. The Director, Case Management will have specific oversight of Medicare and SNP population case management.

ROLE RESPONSIBILITIES

• Build and oversee care management teams and solutions that yield industry-leading medical cost outcomes while aligning with Bright’s Care Partner philosophy.
• Collaborate with Bright’s Medical Directors to establish clinical strategies that enhance program performance and align with Bright’s core objectives, policies, and values
• Support development and ensure compliance with policies and procedures related to corresponding Care management functions
• Coordinate with other leaders of internal and delegated functions at Bright, including utilization management, clinical market teams, claims and line of business leaders, to identify opportunities to smooth the member and provider experience across programs. 
• Contribute to the development of methodology and processes to measure, and evaluate, ongoing clinical program performance
• Establish monitoring processes to validate and document that all of Bright’s CM processes meet all applicable accreditation standards and State and Federal regulatory requirements
• Participate in and/or lead the implementation of new clinical initiatives and/or new market installations in relation to care management
• Develop and maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels (e.g. average speed of answer and abandonment rates)
• Represent the Care Management functions within Bright Committee structures to report program performance and provide operational updates, reporting program performance and operational updates.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree in a related field required. An RN or other clinical licensure is preferred, but not required.
• Eight (8) or more years of professional experience, including five (5) years developing and/or managing clinical programs, products and services required.
• Two (2) years of experience working within a care management or care coordination operation required.
• Experience with Medicare and SNP population case management strongly preferred
• Prior experience with URAC accreditation strongly preferred.
• Formal training in Six Sigma management techniques preferred.

ABOUT US

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.

BRIGHT ON!