Clinical Case Manager
2 weeks ago
Brighton Health Plan Solutions (BHPS) is dedicated to delivering exceptional Case Management services to our clients. The Nurse Case Manager plays a crucial role in overseeing cases and reports directly to the Case Management Manager. This position is responsible for the development and management of the case management program, ensuring effective case management services are provided to our members. Additionally, the Nurse Case Manager is tasked with implementing systems to accurately collect and report program activities and outcomes related to case management.
Key Responsibilities
- Comply with regulatory standards (e.g., ERISA, HIPAA) relevant to Case Management and self-insured clients.
- Employ clinical assessment tools to create tailored care plans for patients.
- Engage with patients, healthcare providers, and DME suppliers to promote favorable health outcomes.
- Inform patients and their families about treatment options, medications, and care objectives.
- Verify insurance coverage for medical expenses.
- Leverage both internal and external resources for effective Case Management.
- Assess the appropriate level of care and resource allocation for complex cases.
- Support discharge planning and evaluate alternative treatment options.
- Maintain precise records of cases to ensure cost-effective care delivery.
- Exhibit compassion, care, and positivity in interactions with clients and colleagues.
- Adhere to BHPS policies and uphold quality assurance standards.
- Participate in quality assurance initiatives.
- Possess relevant licensure(s), specialty certifications, and Case Management Certification.
- A minimum of 2 years of Case Management experience is required, ideally complemented by 4 years of clinical experience.
- Demonstrated proficiency in medical assessment and record review for effective problem-solving and decision-making.
- Ability to independently resolve issues and make critical decisions.
- Strong skills in prioritization, planning, and multitasking.
- Excellent customer service, communication, and organizational abilities.
- Proficient in Microsoft Word, Office, Excel, and familiar with database environments.
- Knowledge of URAC/NCQA standards and experience with Milliman Care Guidelines (MCG) is preferred.
- Bonus: Additional certifications such as Diabetes Educator, Pediatric Nursing, or Gerontological Nursing.
- Current Registered Nurse (RN) license with state licensure; a bachelor's degree is preferred.
At Brighton Health Plan Solutions, LLC, we are committed to enhancing the accessibility and delivery of healthcare. Our culture is diverse and welcoming, emphasizing encouragement, respect, and the promotion of diversity, inclusion, and belonging at every level. We value authenticity and encourage our team members to bring their unique abilities to the workplace.
Brighton Health Plan Solutions collaborates with self-insured employers, Taft-Hartley Trusts, healthcare systems, providers, and other third-party administrators to address the challenges of modern healthcare through our innovative and flexible administration services. Our extensive experience in health plan management, proprietary provider networks, and advanced technology platform enable us to offer customizable solutions that enhance member experiences, improve health outcomes, and help achieve healthcare objectives. Together with our trusted partners, we are redefining the health plan experience, transforming today's challenges into tomorrow's solutions.
Company Mission
To revolutionize the health plan experience by providing outstanding products and services to our partners.
Company Vision
To redefine healthcare quality and value by aligning the incentives of our partners in innovative and impactful ways.
Diversity, Equity, and Inclusion Commitment
At BHPS, we encourage all team members to bring their authentic selves to work, embracing the fullness of their lived experiences. We are dedicated to fostering a culture that prioritizes diversity, inclusion, and a sense of belonging at every level.
- We are an Equal Opportunity Employer.
-
Clinical Case Manager
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full timeJob OverviewPosition SummaryBrighton Health Plan Solutions (BHPS) is seeking a dedicated Nurse Case Manager to oversee and enhance our case management services. This role involves the management of client cases, ensuring that our members receive the highest quality of care. The Nurse Case Manager will report directly to the Case Management Manager and will...
-
Clinical Case Manager
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full timeJob OverviewPosition SummaryBrighton Health Plan Solutions (BHPS) is seeking a dedicated Nurse Case Manager to oversee and enhance our Case Management services. This role involves the comprehensive management of patient cases, ensuring that each member receives tailored care. The Nurse Case Manager will work under the supervision of the Case Management...
-
Clinical Case Manager
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timePosition OverviewBrighton Health Plan Solutions (BHPS) is dedicated to delivering exceptional Case Management services to our clientele. The Nurse Case Manager plays a pivotal role in this process, reporting directly to the Case Management Manager. This position is tasked with the development and oversight of the case management program, ensuring that...
-
Clinical Case Manager
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timeAbout The PositionBrighton Health Plan Solutions (BHPS) is dedicated to delivering exceptional Case Management services to our clients. The Nurse Case Manager plays a pivotal role in overseeing cases and is accountable to the Manager of Case Management. This position is essential for the development and management of the case management program, ensuring...
-
Clinical Case Manager
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full timeJob OverviewPosition SummaryBrighton Health Plan Solutions (BHPS) is seeking a dedicated Nurse Case Manager to oversee and implement case management services for our clients. This role is essential in ensuring that our members receive the highest quality of care while adhering to established guidelines and regulations.Key ResponsibilitiesEnsure compliance...
-
Travel Nurse RN
2 days ago
Chapel Hill, North Carolina, United States TravelNurseSource Full timeAbout the PositionTravelNurseSource is partnering with Host Healthcare to find a qualified Case Manager RN in a dynamic healthcare setting.Job SummaryWe are seeking a skilled Registered Nurse - Case Management to join our team in a fast-paced environment. As a Case Manager RN, you will be responsible for coordinating patient care, developing treatment plans,...
-
Travel Healthcare RN
5 days ago
Chapel Hill, North Carolina, United States TravelNurseSource Full timeAbout the PositionTravelNurseSource is working with Host Healthcare to find a qualified Case Manager RN in a dynamic healthcare setting. We are seeking a skilled and compassionate Registered Nurse to join our team as a Case Manager in a fast-paced environment.Why Choose TravelNurseSource?We are a leading travel healthcare company that offers unparalleled...
-
Clinical Care Coordinator
2 weeks ago
Chapel Hill, North Carolina, United States InsideHigherEd Full timeDepartment:Med-Infectious DiseasesCareer Area:Healthcare ServicesInternal Recruitment:NoPosition Type:Permanent StaffPosition Title:Social Work Practitioner - ContributingSalary Grade Equivalent:GN07Working Title:Clinical Care CoordinatorVacancy ID:P019421Employment Status:Full-Time PermanentWeekly Hours:40Work Schedule:Monday to Friday, 8 AM – 5...
-
Travel Nurse RN
3 days ago
Chapel Hill, North Carolina, United States Host Healthcare Full timeAbout Host HealthcareHost Healthcare is a leading travel healthcare company that offers a range of benefits and perks to its travelers.Job SummaryWe are seeking a Registered Nurse - Case Management to join our team in a dynamic and rewarding role.Key ResponsibilitiesProvide case management services to patients in a hospital setting.Collaborate with...
-
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full timeJob SummaryWe are seeking a highly skilled Utilization Management Nurse to join our team at Brighton Health Plan Solutions, LLC. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care.Key ResponsibilitiesConduct daily medical necessity reviews to determine the...
-
Travel Nurse RN
4 days ago
Chapel Hill, North Carolina, United States Host Healthcare Full timeJob Opportunity: Host Healthcare is an award-winning travel healthcare company with an immediate opening for a Registered Nurse - Case Management in a dynamic healthcare setting.Why Choose Host Healthcare?We offer a supportive and transparent team environment that prioritizes our travelers' needs.Our recruiters act as dedicated travel career mentors and...
-
Clinical Management Coordinator
1 week ago
Chapel Hill, North Carolina, United States Medi-Weightloss Full timeJob OverviewPosition SummaryAre you enthusiastic about promoting health and wellness? Do you enjoy guiding individuals towards achieving their personal and professional aspirations? If you embody a healthy lifestyle and resonate with these values, we invite you to explore a role with us at Medi-Weightloss.As a medically supervised weight loss clinic, our...
-
RN Case Manager
1 week ago
Chapel Hill, North Carolina, United States UNC Health Full timeAbout the RoleThe Care Manager RN plays a vital role in delivering comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication.Key...
-
Nurse Specialist in Utilization Management
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timePosition OverviewBrighton Health Plan Solutions is seeking a dedicated Utilization Management Nurse specializing in Prior Authorization. This role involves conducting medical necessity evaluations on prior authorization submissions in alignment with established national guidelines, contractual obligations, and member benefit coverage while operating in a...
-
RN Case Manager
1 week ago
Chapel Hill, North Carolina, United States UNC Health Full timeAbout the RoleThe Care Manager RN plays a crucial role in providing comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication.Key...
-
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timeAbout The PositionBrighton Health Plan Solutions is dedicated to providing top-tier Utilization Management services. The Utilization Management Nurse is responsible for conducting daily assessments of medical necessity. This role reports directly to the Director of Clinical Programs.This job description is intended to outline the primary responsibilities and...
-
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timeAbout The RoleBrighton Health Plan Solutions (BHPS) is dedicated to delivering exceptional Utilization Management services. The Utilization Management Nurse is responsible for conducting daily assessments of medical necessity. This role reports directly to the Director of Clinical Programs.This job description is intended to outline the primary...
-
Nurse Specialist in Utilization Management
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timePosition OverviewBrighton Health Plan Solutions is seeking a dedicated Utilization Management Nurse specializing in Prior Authorization. This role involves conducting assessments of medical necessity for prior authorization requests, ensuring compliance with established national standards and contractual obligations while working remotely.Key...
-
Clinical Services Manager
2 weeks ago
Chapel Hill, North Carolina, United States Navion Senior Solutions Full timePosition OverviewNavion Senior Solutions is actively seeking a dedicated Clinical Services Manager to oversee the provision of care within our esteemed assisted living and memory care facilities. This leadership role is pivotal in ensuring the highest standards of resident care and service delivery.Key ResponsibilitiesFoster exceptional customer service and...
-
Nurse Specialist in Utilization Management
2 weeks ago
Chapel Hill, North Carolina, United States Brighton Health Plan Solutions Full timeAbout The PositionBrighton Health Plan Solutions is dedicated to providing exceptional Utilization Management services. The Utilization Management Nurse - Prior Authorization is responsible for conducting medical necessity evaluations on prior authorization submissions in line with national guidelines, contractual obligations, and member benefit coverage...
