Case Manager, LVN - Bilingual English & Spanish (Work from Home)

Bright Health; Orlando (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Case Manager to enhance patient-centered care across platforms. The role involves collaborating with various stakeholders, facilitating care coordination, and advocating for members' health outcomes. Candidates with an Associate’s degree in Nursing and bilingual skills are preferred for this dynamic position in Florida.

Qualifications

• Minimum 2 years of experience in medical management clinical functions.
• Bilingual in English and Spanish.
• Licensed Vocational Nurse (LVN) required.

Responsibilities

• Collect relevant clinical data for care planning.
• Facilitate care coordination and health education.
• Ensure member communication meets regulatory standards.

Skills

Critical thinking

Problem-solving

Effective communication

Time management

Flexibility

Organization

Self-motivation

Adaptability

Education

Associate’s degree in Nursing

Tools

MCG standards

InterQual standards

NCQA standards

Job description

Our mission is to make healthcare right. Together. We are a value-driven healthcare companycommitted to providing personalized care to aging and underserved populations. We do this by aligningstakeholders across the healthcare ecosystem. Together, we can improve consumer experience,optimize clinical outcomes, and reduce total cost of care.

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.

The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum.

ROLE RESPONSIBILITIES

• Collect relevant clinical data to support the care planning process
• Care Plan support, intervention, and prioritization to transition members to optimal levels of health and self-management
• Participate in interdisciplinary team meetings as required
• Collaboration across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
• Provide transition of care interventions as required
• Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population
• Facilitate linkage to appropriate community resources to address social determinants of health
• Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
• Ensure member communication and notices are composed in a manner consistent with regulatory standards
• Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Associate’s degree in Nursing, preferred
• Minimum 2 years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards
• Bilingual in English and Spanish

LICENSURES AND CERTIFICATIONS

• Active and Unrestricted License as a Licensed Vocational Nurse (LVN)
• Certification Managed Care Nursing (CMCN) preferred

PROFESSIONAL COMPETENCIES

• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
• Demonstrated flexibility, organization, and self-motivation
• Highly adaptable to change

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.

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Case Manager, LVN - Bilingual English & Spanish (Work from Home) • Florida, US