SCOPE OF ROLE

The Care Manager coordinates and facilitates members’ individualized plans of care in collaboration with members, families, caregivers, and other healthcare 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, and 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 as needed.

ROLE RESPONSIBILITIES

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
• Review all data utilized to create the initial Interdisciplinary Care Plan (ICP), such as HRA, and 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 members 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 members’ 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.

WORK ENVIRONMENT

• 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 $26.21 - $39.32 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.