Nurse Case Manager, Case Management

Brighton Health Plan Solutions is seeking a Nurse Case Manager to develop and manage the case management program, provide case management services to members, and ensure compliance with regulatory regulations.

Requirements

• Adhere to regulatory regulations (e.g., ERISA, HIPAA) for Case Management and self-insured clients.
• Use clinical tools for patient assessment, creating individualized care plans.
• Communicate with patients, physicians, DME providers, etc., to ensure positive outcomes.
• Educate patients and family about treatment plans, medications, and goals.
• Establish insurance coverage eligibility for medical costs.
• Utilize internal and external resources for Case Management.
• Determine appropriate care level and resource utilization for complex cases.
• Facilitate discharge planning and evaluate alternative treatments.
• Maintain accurate records of cases, ensuring cost-effective care.
• Demonstrate compassion, care, and positivity with customers and colleagues.
• Adhere to BHPS policies and quality assurance standards.
• Participate in QA activities.

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Visa Sponsorship
• Four Day Work Week
• Generous Parental Leave
• Tuition Reimbursement
• Relocation Assistance