- Collect relevant clinical data to support the care planning process
- Care Plan support, intervention, and prioritization to transition members to optimal levels of health and self-management.
- Participate in interdisciplinary team meetings as required
- Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
- Provide transition of care interventions as required
- Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
- Facilitate linkage to appropriate community resources to address social determinants of health
- Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
- Ensure member communication and notices are composed in a manner consistent with regulatory standards.
- Adhere to the Policies and Procedures set forth by the Quality Management Committee.
- Associate's degree in Nursing preferred
- Minimum two (2) years of experience in medical management clinical functions required
- Working knowledge of MCG, InterQual, and NCQA standards required
- An active and unrestricted license as a Licensed Vocational Nurse (LVN) is required
- Certification Managed Care Nursing (CMCN) preferred
- High level of critical thinking and problem-solving skills
- Strong work ethic and overall positive attitude
- Effective communication skills including verbal and written
- Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
- Demonstrated flexibility, organization, and self-motivation
- Highly adaptable to change
- The majority of work responsibilities are performed in a home office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Some travel may be required.
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Care Manager - Bloomington, United States - Bright Health
Description
We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.
We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
SCOPE OF ROLE
The role of the Care Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes. The Care Manager is responsible for providing patient centered care across the care continuum.
ROLE RESPONSIBILITIES
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
LICENSURES AND CERTIFICATIONS
PROFESSIONAL COMPETENCIES
WORK ENVIRONMENT
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 $29.08-$43.61 Hourly.
Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, 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.
