The Manager of Case Management will lead a team of clinicians and social workers in the delivery ofcare coordination and case management services. This role will work closely with Bright's Clinical Programs team to influence program designs and associated program policies. The Manager of Case Management will be accountable for the execution of program services according to specifications toimprove care outcomes via interaction with Bright members, their providers and available member support services. This role will embody a philosophy that maintains focus on members' health, leading by serving as an example to assure members and providers have a positive experience with the services they receive. The Manager of Case Management will ensure all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
- Provide leadership and direction to a team of clinicians and support staff, responsible for thedevelopment and completion of personal care plans.
- Coordinate with the Clinical Programs team to provide feedback on program features and associated design principles, based on experience executing the programs.
- Conduct outbound interventions to support to advance member care plans, coordinate care and close clinical gaps.
- Collaborate with Provider Relations, Market Management teams and Care Partner representatives in the management of members' care plans.
- Participate in the development of operating models to execute clinical program solutions, including but not limited to Complex Case Management, Disease Management and Transitions of Care
- Collaborate with organizational leaders, including, but not limited to Network Navigation, Product, Clinical Program Management and Market Performance to identify opportunities for service improvement, including further integration with Bright's Care Partners where appropriate.
- Provide feedback to Program Management team with respect to program design, efficiency, efficacy and member/provider satisfaction.
- Maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
- Recruit, hire and train new team members.
- Support the development and maintenance of standard operating procedures related to corresponding clinical program functions.
- Participate in, and/or lead the implementation of new care coordination initiatives and/or new market installations
- Manage workplans and prioritize resources to meet key deliverables.
- Other duties and responsibilities as assigned.
- Monitor and guide team efforts, providing coaching and development to team members.
- This position has supervisory responsibilities for members of the Population Health team assigned tosupporting Care Coordination and Case Management activities.
Education, Training and Experience
- Bachelor's degree in Nursing
- At least 5 years of experience working within Case Management and/or Care Coordination functions
- At least 2 years of management experience
- Prior experience with URAC accreditation is desired
- Formal training in Six Sigma management techniques is a plus, but not required
- Ability to evaluate complicated problems and isolate contributing factors
- Capable communicator that can interact with others at multiple levels within the organization
- Leads through influence and example
- Strong operational mindset and use data to draw insights
- Thrives on driving results in a collaborative environment
Licensure and Certifications
- Registered Nurse, with license in good standing.
The majority of work responsibilities are performed in an open office setting, carrying out detailed worksitting at a desk/table and working on the computer. Travel, up to 10% of the time may be required.
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.