Clinical Coordinator - Case Management

About The Role
Brighton Health Plan Solutions (BHPS) provides Case Management / Medical Management services to its clients. Clinical Coordinator facilitates case management by performing intake and clinical data collection & entry, clinical intake screening assessment, and effectively communicating with Nurse Case Managers. The Clinical Coordinator reports to the Manager, Case management.

Primary Responsibilities

• Answer and handle phone calls within required time frames.
• Mail/email correspondence, resources, and information to members.
• Collect clinical and demographic data upon notification from patient/patient representative, or physician; verify member eligibility.
• Create cases within Case Management system in accordance with departmental workflows, policies, and procedures.
• Interact telephonically with members and providers and accurately acquire and relay clinical information about medical status, diagnoses, and future care needs.
• Conduct initial intake clinical assessment to determine what acuity/outreach is needed and reassign to RN, if needed, per process.
• Adhere to established quality assurance standards and all BHPS policies and procedures.
• Discuss and document any concerns, complaints and/or issues with direct supervisor.
• Demonstrate the Brighton Values, and a kind, caring, sympathetic and positive attitude with all customers including fellow employees.

Essential Qualifications

• Bachelor’s degree preferred but not required.
• LPN/LVN license required.
• HS diploma or GED is required.
• Strong skills in medical record review.
• Familiarity with medical terminology a plus.
• Excellent customer service and communication skills.
• Ability to think critically, define problems, obtain data, and establish facts.
• Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Word and Excel.
• Excellent data entry skills.
• Ability to work in a database environment a plus.
• Experience in learning various software programs a plus.
• Self-starter with strong organizational skills, the ability to work independently, and complete tasks as identified and/or assigned.

* General Knowledge of HIPAA Confidentiality Laws

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