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BrightSpring Health Services

Home-based health services and pharmacy solutions

Wraparound Facilitator

Case Management & AdvocacyUpdated on Nov 5
Full-timeWheeling, WV, USANo salary listedIn-person

About the Job

Requirements

  • A bachelor's degree in a human services field or nursing field is required.
  • A valid driver's license is required.
  • Two years of experience with case management or a related discipline are required.
  • The candidate must be able to communicate both verbally and in writing.

Responsibilities

  • Receive and respond to calls from referral sources and potential clients, identify client needs, and consult with the Director of Clinical Management to determine whether the company can meet them.
  • Complete viable referrals by conducting pre-screening assessments, preparing pre-screening reports and case proposals, completing related pre-admission paperwork, obtaining payment authorization, and coordinating the availability of an appropriate treatment team.
  • Oversee, direct, and supervise field staff assigned to assist with the pre-screening process.
  • Access national, state, and company account information, including account names and contract terms or prior payer agreements, as appropriate.
  • Consult with third-party representatives about client benefit coverage, financial responsibility, service authorization, and reimbursement procedures; present company services, explain reimbursement options, and negotiate reimbursement levels with third-party payers.
  • Advise referral sources of case acceptance and provide information about the clinical team responsible for each client's case.
  • Maintain knowledge of company services and community resources, and identify alternative community service sources when company services are not appropriate or available.
  • Maintain relationships with referral sources and payer case managers, seek referrals as appropriate, and record call outcomes while keeping the SAR informed.
  • Monitor and report referral-source satisfaction and conversion ratios, and provide summary reports to management at requested intervals.
  • Implement and maintain operational processes with up-line management to ensure compliance with company policies, requirements, and regulatory mandates.
  • Follow and participate in the company's HIPAA privacy practices and business ethics and compliance programs.
  • Participate in quarterly growth-planning meetings and activities, including discussions about staffing and recruitment needs.
  • Participate in special projects and perform other assigned duties.

About the Company

BrightSpring Health Services

Home-based health services and pharmacy solutions

BrightSpring Health Services delivers home and community-based health services for people with complex or chronic needs, organized into two segments: Pharmacy and Provider. The Pharmacy segment provides specialty, infusion, and community pharmacy services to patients with complex conditions. The Provider segment offers behavioral health, home health, hospice care, and services for individuals with intellectual and developmental disabilities. The company runs an integrated care model through a network of pharmacies and providers to support a continuum of care that includes clinical services, care coordination, and in-home support. Revenue comes from Medicare, Medicaid, and private insurance, reflecting reimbursement across public and private payers. The goal is to coordinate pharmacy and in-home health services to improve access, continuity, and outcomes for patients and to serve managed care organizations with a complete care solution.

Company size
10,001+
Company stage
IPO
Headquarters
Lyndon, KY
Founded
1974

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