Clinical Case Manager
Bright Health, Lee's Summit, MO
WE’RE NEW, BUT WE’RE NOT NEW AT THIS.
- 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.
About Bright Health
Here’s the great thing about building a health plan from the ground up. We get to ask "why" at every turn – and make every decision a thoughtful one. But we’re different than other new health insurance companies because we come from big places. Our leaders have decades of experience working in health insurance and are committed to improving the customer experience. They started Bright Health because they know what to do and, more importantly, what not to do when creating a system that will actually work in your favor. Bright Health believes healthcare can be done better. Our carefully selected network: When we sat down to design Bright Health plans, we were thinking about relationships – the one between you and your doctor, and also the one between us and your doctor. Then we set out to create purposeful partnerships with caring providers. We call them our Care Partner. Our tight-knit network gives you access to a community of compassionate providers who are working together with us and with each other to help you live Brighter. Our commitment to service: When you need care, you want someone familiar who can help you, someone who actually feels good to interact with. And in-between visits to the doctor, you want someone who will help you thrive. So with any Bright Health plan, you get us, your Bright Health Team. We’re here, ready to help. No matter if your question is “Can I see this doctor?” or “How much is covered?” it’s easy to reach a real person who can get you the right answers and help you find the right care. There, that’s better. Our Whole Health Rewards: Keeping good health extends far beyond how many steps you take, what your BMI is, or what kind of food you eat. Don’t get us wrong, those things certainly contribute to your well-being but there’s a whole lot more to the picture. We provide opportunities for you to earn $$ throughout the year for making good decisions that lead to a Brighter life. When you and your health plan both want what’s best for you – it makes staying well a whole lot easier.
Want to learn more about Bright Health? Visit Bright Health's website.
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