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Our mission is to make healthcare right. Together. We are a value-driven
healthcare company committed to providing personalized care to aging and
underserved populations. We do this by aligning stakeholders across the
healthcare ecosystem. Together, we can improve consumer experience, optimize
clinical outcomes, and reduce total cost of care.
What drives our mission? The company values we live and breathe every day. We
keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be
If you share our passion for changing healthcare so all people can live
healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Care Manager coordinates and facilitates members’ individualized plan of
care in collaboration with members, families, caregivers, and other health
care providers. The Care Manager uses their clinical judgment to determine a
member’s needs both in the home and throughout an acute care episode. The Care
Manager provides support, guidance, education, and acts as a liaison between
the member’s PCP and specialty physicians to maximize health outcomes and
prevent unnecessary hospitalizations. This role also supports a variety of
care programs, outreach, education, quality improvement, and other initiatives
The Care Manager job description is intended to point out major
responsibilities within the role, but it is not limited to these items.
- Conducts face-to-face visits with members in both healthcare facilities and in their homes and initiates telephone outreach
- Reviewing all data utilized to create the initial Interdisciplinary Care Plan (ICP), such as HRA, claims/pharmacy data, and revise and approve the initial ICP and assigned risk level, if necessary.
- Facilitate “Intakes” and maintain required documentation in EMR web-based application including but not limited to the following: Surveys, Health Risk Assessments, progress notes, and other documentation as required by Bright Health.
- Uses all components of the Transition of Care model and nursing process including assessment, triage, planning, implementing, and evaluating care to meet the members’ needs
- Provides health maintenance, medication, and disease management education to members and families/caregivers
- Coordinates appropriate member care appointments, community resources, referrals, management program benefits and special focus programs
- Ensure member’s preventive care appointments are scheduled and encourage member to participate in those appointments.
- Maintains compliance with CMS mandated health risk assessments, care plans, and interdisciplinary care team requirements.
- Active participation in Interdisciplinary Care Team presentations, if indicated.
- Coordinates continuity of care, prevention and avoidance of complications, and close clinical treatment and management under the direction of the members’ primary healthcare provider(s) and medical directors
- Takes an active role in coordinating and initiating member’s access to Bright Health programs and specialty benefits offered beyond traditional Medicare
- Effectively communicates, problem-solves, and maintains productive and effective interpersonal relationships while effectively prioritizing patient care.
- Works with outside facilities, agencies, and vendors on a routine basis, maintaining positive working relationships
- Supports members and their families/caregivers, and provides compassionate care
- Frequent travel is required for member visits, conferences, community events, health fairs, etc.
- Make referrals/linkages to community resources on an individualized basis.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Current Licensed Practical Nursing or Licensed Vocational Nurse certificate from an accredited Nursing Program
- Two (2) or more years' experience as an LPN/LVN, preferably in a case management setting
- Driver’s license, auto insurance, and safe driving history
- One (1) year of healthcare related experience required
- Awareness and experience with HIPAA requirements for healthcare communications preferred
- Prior experience with URAC/NCQA accreditation preferred
- Bilingual preferred
LICENSURES AND CERTIFICATIONS
- Current Licensed Practical Nursing or Licensed Vocational Nurse certificate from an accredited Nursing Program; or equivalent combination of education and experience.
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Travel, up to 10% of the time may be required.
For individuals assigned to a location(s) in California, Bright Health is
required by law to include a reasonable estimate of the compensation range for
this position. Actual compensation will vary based on the applicant’s
education, experience, skills, and abilities, as well as internal equity. A
reasonable estimate of the range is $28.31 - $42.47 hourly.
Additionally, employees are eligible for health benefits; life and disability
benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid
holidays, plus 2 floating holidays per year; and a lifestyle spending account.
As an Equal Opportunity Employer, we welcome and employ a diverse employee
group committed to meeting the needs of Bright Health, our consumers, and the
communities we serve. All qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation, gender
identity or expression, marital status, genetic information, or any other
characteristic protected by law.