Case Management Nurse, Behavioral Health

🔥 2 minutes ago

🌵 Arizona, Connecticut, +13 more states – Remote

🌵 Arizona – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Brighton Health Plan Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Brighton Health Plan Solutions is a healthcare enablement company transforming the healthcare landscape through innovative technology and customized health plans. With over 30 years of experience in third-party administration, the company specializes in health plan management, direct contracting for employers, and integrated ancillary benefits. Brighton Health Plan Solutions provides advanced technology platforms to simplify administrative tasks and enhance member engagement. They serve as a crucial link in direct contracting between groups and health systems, providing administrative and provider contracting expertise. By aligning stakeholders and creating flexible health plan products, they strive to improve healthcare delivery and outcomes.

📋 Description

• Conduct comprehensive medical, behavioral health, psychosocial, functional, and care coordination assessments • Develop, implement, monitor, and update individualized member-centered care plans • Coordinate care across the healthcare continuum to promote quality outcomes, appropriate utilization, member engagement, and cost-effective care • Educate and coach members and caregivers on health conditions, treatment plans, medications, preventive care, and self-management • Identify and address barriers to care, treatment adherence, health equity, and care plan goals • Facilitate transitions of care and access to medical, behavioral health, and community-based services • Perform outreach, monitoring, reassessment, and follow-up; modify care plans as needed • Collaborate with members, caregivers, providers, community resources, interdisciplinary teams, and internal stakeholders • Apply evidence-based guidelines, clinical criteria, nursing judgment, and care management best practices • Identify care gaps, emerging risks, and intervention opportunities • Present complex cases during interdisciplinary case reviews • Maintain complete and timely documentation in accordance with organizational, regulatory, and accreditation standards • Ensure compliance with NCQA Care Management standards, HIPAA, applicable regulations, and organizational policies • Participate in quality improvement initiatives, audits, accreditation activities, performance improvement projects, and professional development • Report to the Supervisor, Case Management (LCSW), with a dotted-line relationship to the Senior Director, Case Management (RN)

🎯 Requirements

• Current, active, unrestricted Registered Nurse (RN) license required • Compact (Multistate) Nursing Licensure required • New York State RN licensure highly preferred; candidates without it must obtain NYS licensure within 30 days of hire • Bachelor of Science in Nursing (BSN) preferred; Associate Degree in Nursing (ADN) with relevant experience considered • Minimum two years of nursing experience in case management, care management, population health, behavioral health, managed care, utilization management, or related clinical setting • Clinical knowledge of assessment, care planning, chronic condition management, behavioral health integration, and care coordination • Experience conducting comprehensive clinical assessments and developing individualized, member-centered care plans • Knowledge of care management principles, healthcare delivery systems, community resources, and behavioral health service systems • Understanding of NCQA Care Management standards and applicable state and federal regulatory requirements • Strong clinical assessment, medical record review, critical thinking, and problem-solving skills • Ability to identify care gaps, barriers to care, and opportunities to improve member outcomes • Excellent verbal and written communication skills • Ability to prioritize workload, manage multiple assignments, and work independently with minimal supervision • Proficiency in Microsoft Office and electronic medical record, case management, and database systems • Commitment to member confidentiality and HIPAA compliance • Ability to adapt to changing priorities and support quality and accreditation requirements • Certified Case Manager (CCM), Accredited Case Manager (ACM), Behavioral Health certification, or other relevant certification preferred • Experience in managed care, Medicare, Medicaid, commercial health plans, or population health programs preferred • Experience within an NCQA-accredited health plan strongly preferred • Knowledge of evidence-based care management, motivational interviewing, and member engagement strategies • Strong organizational, analytical, and decision-making skills • Ability to collaborate across multidisciplinary teams and with community-based providers • Bilingual Spanish-speaking skills preferred but not required

🏖️ Benefits

• Diverse and welcoming culture focused on encouragement, respect, diversity, inclusion, and belonging • Ongoing professional development • Equal Opportunity Employer

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