Remote Complex Care Manager (RN)

Brighton Health Plan Solutions, LLC; Chapel Hill (NC); Remote; USD 70,000 - 95,000; Full time

Job summary

Brighton Health Plan Solutions, LLC seeks a Complex Case Manager (RN) to oversee a caseload of members with complex medical and care coordination needs. The role reports to the Supervisor, Case Management and collaborates with the Senior Director, Case Management for clinical guidance.

This is a remote position with responsibility for comprehensive assessments, care plan development, transitions of care, and coordination with interdisciplinary teams while maintaining HIPAA and NCQA standards.

Qualifications

• Active, unrestricted RN license required.
• Compact multistate licensure required; NYS licensure preferred.
• BSN preferred; ADN with relevant experience considered.
• Minimum 2 years in care management or related clinical setting.

Responsibilities

• Conduct comprehensive assessments to identify complex medical, psychosocial, functional, utilization, 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.

Skills

RN license

Care coordination

Clinical assessment

Communication

Independent work

Education

BSN preferred

ADN with experience considered

Tools

EMR systems

Microsoft Office

Job description

Brighton Health Plan Solutions, LLC seeks a Complex Case Manager (RN) to oversee a caseload of members with complex medical and care coordination needs. The role reports to the Supervisor, Case Management and collaborates with the Senior Director, Case Management for clinical guidance.

This is a remote position with responsibility for comprehensive assessments, care plan development, transitions of care, and coordination with interdisciplinary teams while maintaining HIPAA and NCQA standards.