Remote Complex Case Manager - RN Care Coordinator

Brighton Health Plan Solutions, LLC; Oregon; Hybrid; USD 80,000 - 110,000; Full time

Job summary

Brighton Health Plan Solutions, LLC is seeking a Complex Case Manager to oversee a caseload of members with complex medical needs. The role reports to the Supervisor, Case Management and collaborates with an interdisciplinary team to coordinate care and improve outcomes.

This is a remote position within the United States, with responsibilities including care planning, education, and program oversight. The ideal candidate holds an active RN license with compact licensure, preferably NY, and 2+

Qualifications

• Current, active, unrestricted RN license required.
• Compact (Multistate) licensure required; NY RN license preferred; must obtain NYS licensure within 30 days of hire.
• BSN preferred; ADN with relevant experience considered.
• Minimum two years of nursing experience in care management or related clinical setting.
• Knowledge of NCQA Care Management standards and care coordination best practices.
• Experience with comprehensive clinical assessments and care planning.
• Excellent communication and ability to work independently.

Responsibilities

• Conduct comprehensive assessments to identify complex medical and care coordination needs.
• Develop and monitor individualized, member-centered care plans in collaboration with teams.
• Coordinate care across the healthcare continuum to ensure quality outcomes and cost-effective care.
• Provide education and coaching on health conditions, treatment plans, and self-management.
• Identify barriers to care and opportunities to improve member outcomes.
• Document assessments, care plans, and progress in EMR accurately and timely.
• Ensure compliance with NCQA Care Management standards, HIPAA, and regulations.
• Participate in quality improvement initiatives and professional development.

Skills

Clinical assessment

Care coordination

Communication skills

Critical thinking

Prioritization

Independent work

Education

BSN preferred

ADN with relevant experience considered

Tools

Electronic medical record systems

Microsoft Office

Job description

Brighton Health Plan Solutions, LLC is seeking a Complex Case Manager to oversee a caseload of members with complex medical needs. The role reports to the Supervisor, Case Management and collaborates with an interdisciplinary team to coordinate care and improve outcomes.

This is a remote position within the United States, with responsibilities including care planning, education, and program oversight. The ideal candidate holds an active RN license with compact licensure, preferably NY, and 2+