brightonhealthplansolutions
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
Vice President, Contribution Accounting & Enrollment Eligibility
About The RoleThe Contribution Accounting & Enrollment Leader is responsible for the strategic direction, operational oversight, and performance of the Contribution Accounting & Enrollment function within a multi-employer health and welfare fund administration environment. This role ensures the accu
Vice President, Contribution Accounting & Enrollment Eligibility
Medical Director
About The RoleThe Medical Director performs utilization review and medical necessity determinations for BHPS-administered self-funded commercial plans, and supports the Chief Medical Officer in maintaining the quality, consistency, and defensibility of the department’s clinical decisions. Clinical r
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