brightonhealthplansolutions
Clinical Operations Analyst
About The RoleThe Clinical Operations Analyst serves as the operational and technical backbone of the Medical Management department. This role bridges clinical program operations, platform configuration, data analytics, and training to ensure that BHPS’s clinical teams—spanning Utilization Managemen
Account Executive
About The RoleBrighton Health Plan Solutions is seeking an experienced Account Executive with deep expertise in commercial, self-insured employer benefit plans with 1000+ subscribers, PPO network strategies, and Third-Party Administration (TPA) organizations. This role is primarily focused on client
Senior Director, Case Management & Outcomes Performance
About The RoleBrighton Health Plan Solutions (BHPS) is a Third Party Administrator (TPA) serving 400,000+ commercial members across employer-sponsored self-insured plans and proprietary network products, including MagnaCare. The Senior Director, Case Management & Outcomes Performance is a senior cli
Quality Supervisor
About the RoleThe Quality Department supervisor is responsible for coaching, mentoring, and training the Quality Department Auditors. The supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides
Clinical Appeal Nurse
About the RoleBHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and benefit reviews in a quality-focused, production-driven environment. The
Manager, Provider Compliance
About the RoleBrighton Health Plan Solutions is seeking an experienced Manager of Provider Compliance to lead and oversee the investigation and resolution of provider disputes related to the No Surprises Act. The Manager of Provider Compliance is responsible for directing and reviewing all determina
Medical Director
About The RoleThe Medical Director will be responsible in providing support to our commercial and worker’s compensation self-funded clients seeking cost effective resolution of their member’s claims. Your interest and help leading and developing our team and maturing the program only makes the oppor
Vice President, Enrollment and Eligibility
About The RoleThe Vice President of Enrollment and Eligibility is responsible for providing strategic direction and management of the Enrollment and Eligibility Department. The VP will be a highly motivated leader with a demonstrated track record of success meeting or exceeding established objective
Senior Accountant
About the RoleBHPS has a great opportunity for a Senior Accountant to join the Finance Team. Reporting to the Finance Manager, the Senior Accountant will be responsible for day-to-day accounting transactions and assisting with the financial close process, including performing analysis and reconcilia
Enrollment and Eligibility Manager
About The RoleBPHS is seeking an experienced Manager for our new Enrollment and Eligibility Department. This role will manage all operations of the Enrollment, Employer Services, Escalation, and Quality Assurance areas. The role will workclosely with Employers, oversee daily communication (emails, i
Utilization Management Nurse
About The RoleBHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.Primary Responsi