Manager, Case Management at Bright Health
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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
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.
The Manager, Case Management job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- 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.
- Manage workplans and prioritize resources to meet key deliverables.
- Other duties and responsibilities as assigned.
This position has supervisory responsibilities for members of the Population Health team assigned to supporting Care Coordination and Case Management activities.
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
- 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) license is required
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel, up to 10% of the time may be required.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.