Case Manager, RN (Work from Home)

Bright Health; California (MO); Remote; USD 72,000 - 109,000; Full time

Job summary

An innovative healthcare company is seeking a dedicated Case Manager to enhance the quality of care for aging and underserved populations. In this pivotal role, you will assess patient needs, develop care plans, and coordinate with various healthcare providers to ensure optimal health outcomes. Your expertise will help facilitate transitions of care and connect individuals with essential community resources, all while working in a collaborative environment that values inclusivity and accountability. If you are passionate about making a difference in healthcare and improving lives, this opportunity is for you.

Benefits

Health Benefits

Life and Disability Benefits

401(k) Savings Plan with Match

Paid Time Off

Paid Holidays

Qualifications

• Minimum two years of experience in medical management clinical functions.
• Active RN License in California required.

Responsibilities

• Assess medical, social, and behavioral needs of assigned population.
• Coordinate care plans and facilitate interdisciplinary team meetings.
• Link members to community resources for health and social outcomes.

Skills

Medical Management

Care Coordination

Patient Advocacy

Assessment Skills

Communication Skills

Education

Registered Nurse (RN) License

Certification in Case Management (CCM)

Managed Care Nursing (CMCN)

Tools

MCG Standards

InterQual Standards

NCQA Standards

Job description

Our mission is to make healthcare right. Together. We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders 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.

SCOPE OF ROLE

The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members 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

• Assessment of the medical, social, and behavioral needs of an assigned population
• Care Plan development and prioritization to transition members to optimal levels of health and self-management.
• Capacity to coordinate 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
• Capacity to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care settings
• Able to 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.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Minimum two (2) years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards

LICENSURES AND CERTIFICATIONS

• Active and Unrestricted License as a Registered Nurse (RN) in the state of California
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred

WORK ENVIRONMENT

• 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.
• Some travel may be required.

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $72,068 - $108,104 annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.

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.