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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 Clinical Case Manager III assists Bright members by coordinating care across multiple clinical providers, assist with establishing social support services, and/or providing education for self-care and monitoring practices. These services are guided by established policies and procedures, developed by Bright’s Clinical Programs team. This role embodies a philosophy that maintains focus on improving members’ health and supporting a positive service experience. The Case Manager will ensure all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
The Clinical Case Manager III job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Work with members, their providers and applicable care teams to develop personal care plans associated with medical, behavioral and/or social situations.
- Act as lead and provide guidance to colleagues on polices and processes used delivery care to our members.
- 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
- Advanced clinical certification preferred
- Proficiency of Bright internal systems, processes, and policies is a plus
- 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), or Licensed Clinical Social Worker (LCSW) 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 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.