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 members 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

The Care Manager LVN job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Capacity to 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.
• Capacity to participate in interdisciplinary team meetings as required
• Collaboration 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
• Capacity to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
• Able to ensure member communication and notices are composed in a manner consistent with regulatory standards.
• Adheres to the Policies and Procedures the Quality Management Committee sets forth.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Associate’s degree in Nursing preferred
• Bilingual in English/Spanish or English/Chinese highly preferred
• Minimum two (2) years of experience in medical management clinical functions required
• Working knowledge of MCG, InterQual, and NCQA standards required

LICENSURES AND CERTIFICATIONS

• An active and unrestricted license as a Licensed Vocational Nurse (LVN) is required
• Certification Managed Care Nursing (CMCN) preferred

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.
• Some travel 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, abilities, and internal equity. A reasonable estimate of the range is $28.31-$42.47 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.