Job Information
Brighton Health Plan Solutions, LLC Clinical Coordinator - Case Management in New York, New York
About The Role
BHPS provides Case Management/Utilization Review services to its clients. The Clinical Coordinator facilitates case Management by performing intake and data collection, entry and clinical screening assessments. The Case Management Department is supervised by the Manager of Case Management daily. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Primary Responsibilities
Supports clinical team with case documentation including telephonic outreach, to acquire and relay clinical information about medical status, diagnosis, and future care needs.
Adheres to established quality assurance standards and all BHPS policies and procedures.
Conduct initial intake assessments to determine member acuity level and relay status to leadership team.
Review of risk stratification listings for CM candidates and monitors for case assignment volume.
Support vendor management providers as necessary with communications, report gathering and preparation, as well as invoice management.
Identifies any cases with potential quality or utilization concern.
Discusses and documents any concerns, complaints and/or issues with leadership.
Collaborates with Quality Manager to ensure Departmental and individual compliance with URAC and NCQA standards.
Generates reports for both client(s) and BHPS management team to ensure department obligations are met and performance monitoring is ongoing.
Adjunct support for reporting, oversight, and management of delegated entities as needed.
Participates in QA activities.
Essential Qualifications
LPN/LVN licensure required (must maintain active licensure in state of residence).
Strong skills in medical assessment/medical record review.
Strong organizational and task prioritization skills.
Excellent customer service skills, including written and oral communication skills.
Ability to define and solve problems, collect data, establish facts and make effective decisions a must.
Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Word, Office and Excel.
Ability to work in a database environment.
Experience with Milliman Care Guidelines (MCG) preferred.
Experience with URAC/NCQA standards.
Preferred Qualifications
Experience with Milliman Care Guidelines (MCG) preferred.
Experience with Jiva platform.
Minimum of 4 years’ experience in a clinical environment preferred.
2 years’ experience in Case Management preferred.
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer
Annual Salary Range: $55,000 - $65,000
The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com
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