RN Case Manager

Title: RN Case Manager

Job Type: Full-time

Location: Hybrid — 4 days per week in Brighton, MA office; 1 day remote

FLSA Status: Exempt

About Us

BrightonOne is a nonprofit social enterprise delivering healthcare, housing, and hope to veterans and military-connected families, with enterprise discipline in service to those who served.

Position Overview

The RN Case Manager provides telephonic case management (field-based visits are not part of the current program but may be introduced in the future) to US Family Health Plan (USFHP) members with chronic, complex, or high-risk conditions. The role is a key point of contact for internal and external stakeholders, ensuring member care management aligns with BrightonOne's mission and regulatory guidelines. The RN independently conducts comprehensive assessments, develops and executes individualized care plans, and coordinates care across providers, settings, and community resources to improve clinical outcomes, close care gaps, and enhance the member experience for veterans and military-connected families.

Key Responsibilities

Assessment & Care Planning

• Identify and engage eligible members through referrals, risk stratification, and outreach; obtain member consent and enroll members in case management.
• Conduct comprehensive assessments across clinical, behavioral, functional, medication, and psychosocial domains using standardized tools and screenings.
• Develop, implement, and continually update individualized, member-centered care plans with measurable, time-bound goals and scheduled reassessment.
• Apply motivational interviewing and health-coaching techniques to strengthen engagement, adherence, and self-management.
• Screen for behavioral health and safety risks, including depression, substance use, and suicide risk, and connect members to crisis and behavioral health services as needed.

Condition & Complex Care Management

• Manage members across chronic and complex conditions and high-risk/high-cost cohorts.
• Support medication management and adherence in partnership with pharmacy, including medication reconciliation and resolution of gaps or barriers.
• Coordinate services, durable medical equipment, home health, and specialty resources for members with catastrophic or multi-comorbid conditions.

Care Coordination & Transitions

• Collaborate with PCPs, specialists, utilization management, referral management, pharmacy, and behavioral health to align care.
• Support safe transitions of care and proactively address gaps to reduce avoidable admissions and ER use.
• Close HEDIS and preventive-care gaps and link members to community, veteran-specific, and social-determinant resources.
• Educate members and caregivers on conditions, treatment plans, and benefits, and advocate for members as they navigate the health system.

Documentation & Outcomes

• Maintain accurate, timely documentation in the care management platform meeting TRICARE/USFHP and NCQA/accreditation standards.
• Track goal attainment, engagement, and outcome/quality metrics; identify and escalate high-acuity members and safety concerns per protocol.
• Determine readiness for case closure based on goal attainment, and complete closure documentation and member notification.
• Participate in interdisciplinary case rounds, quality improvement initiatives, and documentation audits.
• Maintain member confidentiality in compliance with HIPAA and organizational privacy policies.