Clinical Coordinator, Case Management

About The Role Brighton Health Plan Solutions (BHPS) provides Case Management / Medical Management services to its clients. The Clinical Coordinator facilitates case management by performing intake, 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 patients, patient representatives, or physicians; verify member eligibility. Create cases within the Case Management system following departmental workflows, policies, and procedures. Interact telephonically with members and providers to acquire and relay clinical information about medical status, diagnoses, and future care needs. Conduct initial intake clinical assessments to determine acuity/outreach needs and reassign to RNs if necessary. Adhere to established quality assurance standards and all BHPS policies and procedures. Discuss and document concerns, complaints, and issues with the supervisor. Demonstrate Brighton Values and maintain a kind, caring, positive attitude with all customers and colleagues. Essential Qualifications Bachelor’s degree preferred but not required. LPN/LVN license preferred. HS diploma or GED required. Strong skills in medical record review. Familiarity with medical terminology is a plus. Excellent customer service and communication skills. Critical thinking, problem definition, data collection, and fact establishment abilities. Proficient computer skills, including Microsoft Word and Excel. Excellent data entry skills. Experience with databases and learning new software programs is a plus. Self-starter with strong organizational skills, able to work independently and complete tasks efficiently. About Brighton Health Plan Solutions Our team is committed to improving healthcare access and delivery. We foster a diverse, inclusive, and respectful culture that encourages authenticity and unique abilities. We partner with various healthcare entities to provide innovative, flexible third-party administration services, leveraging decades of expertise, proprietary networks, and advanced technology to enhance member experience, improve outcomes, and meet healthcare goals. Company Mission Transform the health plan experience by delivering outstanding products and services to our partners. Company Vision Redefine healthcare quality and value by aligning incentives in powerful and innovative ways. DEI Purpose Statement We promote bringing your authentic self to work, respecting diverse experiences, and fostering a culture of increasing diversity, inclusion, and belonging at every level. We are an Equal Opportunity Employer.

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