“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 Manager, Case Management leads a team of clinicians and social workers in the delivery of care coordination and case management services. This role works closely with our Clinical Programs team to influence program designs and associated program policies. The Manager of Case Management is accountable for the execution of program services according to specifications to improve care outcomes via interaction with Bright members, their providers and available member support services. This role embodies a philosophy that maintains focus on members’ health, leading by serving as an example to assure members and providers have a positive experience with the services they receive. The Manager of Case Management ensures all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.

ROLE RESPONSIBILITIES

• Provide leadership and direction to a team of clinicians and support staff, responsible for the development and completion of personal care plans.
• Coordinate with the Clinical Programs team to provide feedback on program features and associated design principles, based on experience executing the programs.
• Conduct outbound interventions to support 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.
• Participate in, and/or lead the implementation of new care coordination initiatives and/or new market installations
• Recruit, hire and train new team members.
• Maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
• Monitor and guide team efforts, providing coaching and development to team members.
• Support the development and maintenance of standard operating procedures related to corresponding clinical program functions.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree in Nursing or related field is required
• Five (5) or more years of experience working within Case Management and/or Care Coordination functions
• Two (2) or more years of management experience
• Prior experience with URAC accreditation is desired
• Formal training in Six Sigma management techniques is a plus, but not required

PROFESSIONAL COMPETENCIES

• 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

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!