Nurse Case Manager - Population Health

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™.

Nurse Case Manager Population Health (CM) Brighton Health Plan Solutions REMOTE – 100% Full Time 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 and population health management program.

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.