Nurse Case Manager Job at Brighton Health Plan Solutions, LLC, Chapel Hill, NC

TEgzSHcwQnJhTmRyblptTWFQZ05XeDdLN3c9PQ==
  • Brighton Health Plan Solutions, LLC
  • Chapel Hill, NC

Job Description

About The Role

Brighton Health Plan Solutions (BHPS) provides Case Management services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager reports to the Manager of Case Management. Responsible for developing and managing the case management program and providing case management services to members. This position is also responsible for assuring appropriate systems are in place to collect and report program activities and outcomes for case management program.

Primary Responsibilities
  • Adheres to regulatory regulations (e.g., ERISA, HIPAA) for Case Management and self-insured clients.
  • Uses clinical tools for patient assessment, creating individualized care plans.
  • Communicates with patients, physicians, DME providers, etc., to ensure positive outcomes.
  • Educates patients and family about treatment plans, medications, and goals.
  • Establishes insurance coverage eligibility for medical costs.
  • Utilizes internal and external resources for Case Management.
  • Determines appropriate care level and resource utilization for complex cases.
  • Facilitates discharge planning and evaluates alternative treatments.
  • Maintains accurate records of cases, ensuring cost-effective care.
  • Demonstrates compassion, care, and positivity with customers and colleagues.
  • Adheres to BHPS policies and quality assurance standards.
  • Participates in QA activities.
Essential Qualifications
  • Maintain relevant licensure(s), specialty certifications, and Case Management Certification.
  • 2 years’ Case Management experience required, preferably with 4 years' clinical experience.
  • Strong medical assessment/record review skills for effective problem-solving and decision-making.
  • Independent problem resolution and critical decision-making abilities.
  • Excellent prioritization, planning, and multitasking skills.
  • Effective customer service, communication, and organizational skills.
  • Proficiency in Microsoft Word, Office, Excel, and working in a database environment.
  • Familiarity with URAC/NCQA standards, Milliman Care Guidelines (MCG) experience preferred.
  • Bonus: Additional certifications like Diabetes educator, Pediatric Nursing, Gerontological Nursing.
  • Current licensed Registered Nurse (RN) with state licensure; bachelor’s degree preferred.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement  

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

 

JOB ALERT FRAUD:   We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.  Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section.  If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to:  recruiting@brightonhps.com

Job Tags

Full time, Local area, Flexible hours,

Similar Jobs

Rutgers University

Training and Consultation Specialists | Rutgers University Job at Rutgers University

 ...Robert Wood Johnson Medical School. Provides advanced level coaching, technical assistance and training services consistent with identified...  ...by the project Director; and demonstrates the use of an agile training style that adjusts/differentiates to the needs of participants... 

AO GLOBE LIFE

Customer Service Specialist (Delivering Veteran Benefits) Job at AO GLOBE LIFE

 ...customer service representatives! Enjoy the freedom of working from home while making a positive impact on our Veterans. Why...  ...Potential: Competitive pay with no caps on commissions! Weekly Pay Schedule: Get paid weekly for your hard work. Bonuses & Incentives:... 

MasterBrand Cabinets LLC

Manager, Logistics Optimization Job at MasterBrand Cabinets LLC

 ...experiences together! Job Description This position will manage the Scheduling Team to optimize customer delivery routing while...  ...impact of plant performance, customer service and overall Logistics cost for the business. Leveraging analytical problem solving skills... 

Gpac

Commercial Roofing Estimator Job at Gpac

 ...are excited to announce that we have partnered with a high level Roofing Company in the Denver market. They have a diverse portfolio and...  .... They are in need of an experienced Commercial Roofing Estimator and or a skilled Project Manager. The Estimator calculates preliminary... 

Domino's Franchise

Customer Service Rep - 424 S. Bloomington Job at Domino's Franchise

Job Description ABOUT THE JOB You got game? You got spring in your step? You want the best job in the world! And schedules that work with you, not against you? That's right, we live to beat the rush and make it possible to make, bake or take pizzas during the hungry...