Impactful Behavioral Health Case Manager RN

Brighton Health Plan Solutions, LLC; Chapel Hill (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Brighton Health Plan Solutions, LLC is seeking an experienced RN Case Manager to lead comprehensive assessments and develop member-centered care plans in collaboration with care teams in North Carolina.

You will coordinate care across the healthcare continuum, educate members, and monitor progress to improve outcomes while ensuring regulatory compliance and quality standards. This role requires a valid RN license and prior case management experience.

Qualifications

• Current, active RN license is required.
• Compact (multistate) licensure required; NY RN licensure preferred; ability to obtain NYS licensure within 30 days of hire.
• BSN preferred; ADN with relevant experience considered.
• Minimum two years of nursing experience in case management, care management, population health, behavioral health, or related clinical setting; behavioral health experience preferred.
• Experience in behavioral health case management, psychiatric nursing, substance use disorder treatment, integrated care, or coordination of behavioral health services preferred.
• Knowledge of NCQA Care Management standards, HIPAA, and applicable state and federal regulations.

Responsibilities

• Conduct comprehensive assessments to identify medical, behavioral health, psychosocial, functional, and care coordination needs.
• Develop, implement, monitor, and update individualized, member-centered care plans in collaboration with members, caregivers, providers, and interdisciplinary teams.
• Coordinate care across the healthcare continuum to promote quality outcomes, appropriate utilization, member engagement, and cost-effective care.
• Provide education and coaching to members and caregivers regarding health conditions, treatment plans, medications, preventive care, and self-management strategies.
• Identify and address barriers to care, treatment adherence, health equity, and achievement of care plan goals.
• Facilitate transitions of care and support timely access to medical, behavioral health, and community-based services.
• Perform ongoing outreach, monitoring, reassessment, and follow-up to evaluate progress toward goals and modify care plans as needed.
• Collaborate with members, caregivers, providers, and community resources to support coordination of care and continuity of services.
• Utilize evidence-based guidelines, clinical criteria, nursing judgment, and care management best practices to support clinical decision-making and interventions.
• Identify gaps in care, emerging risks, and opportunities for intervention to improve member outcomes and reduce avoidable utilization.
• Present complex cases during interdisciplinary case reviews and participate in collaborative care planning and problem-solving activities.
• Collaborate with Utilization Management, Population Health, Behavioral Health, Medical Directors, and other stakeholders to support integrated care delivery.
• Maintain accurate, timely documentation of assessments, care plans, interventions, member progress, and coordination activities in line with standards.
• Ensure compliance with NCQA Care Management standards, HIPAA, and regulatory requirements.
• Participate in quality improvement initiatives, audits, accreditation activities, and performance improvement projects.
• Perform other duties as assigned.

Skills

RN license

Education

BSN (preferred)

Job description

Brighton Health Plan Solutions, LLC is seeking an experienced RN Case Manager to lead comprehensive assessments and develop member-centered care plans in collaboration with care teams in North Carolina.

You will coordinate care across the healthcare continuum, educate members, and monitor progress to improve outcomes while ensuring regulatory compliance and quality standards. This role requires a valid RN license and prior case management experience.