RN Nurse Case Management Manager, Work from Home, California

Position Scope:

• Manages approximately 12-15 direct reports who are directly responsible for inpatient case management and all associated performance requirements for Cigna.
• Interfaces with customers as part of service marketing/account management team
• Supports corporate, customer, product, and business initiatives.
• Supports corporate Strategic Business Plan
• Participates in national teams and committees, as needed.
• Communicates with all levels of staff within Health Facilitation Centers, Home Office departments; externally with customers, medical providers, vendors, claims payors, and insurance professionals.
• Participates in or leads projects/activities and reports progress or barriers to Manager
• Build solid working relationships with staff, customers, other key functional areas and providers

Summary description of position:

This position has responsibility to ensure customer satisfaction through operational delivery of quality case management services.  Maintains a team of Inpatient Case Management staff and manages their performance and outcomes to the needs of the customer and corporate standards.  Acts as liaison and collaborates with all matrix partners within the organization - Quality, Medical, Product, Systems, Training, Sales, and Health Services staff.

Major responsibilities and desired results:

• Recruits, selects and hires qualified Inpatient Case Management staff
• Maintains quality improvement and ongoing personal development of all staff.
• Supervises, monitors, and reviews performance of an Inpatient Case Management team to assure that inpatient case management services are delivered promptly, cost effectively, courteously and according to Policy and Procedure, Case Management Standards, and Quality Assurance standards.
• Manages annual and semi-annual performance evaluation process, individual discussion and feedback, and compensation for all team members.
• Collaborates with Quality team for quality improvement opportunities and appropriate actions.
• Partners with matrix members for the development of appropriate work plans and takes corrective action when necessary to ensure that objectives, standards, policies and procedures are met
• Manages appropriate level of follow-up for all work plan and individual performances.
• Acts as liaison and problem-solver between Inpatient Case Managers and matrix partners.
• Evaluates ongoing and future staff requirements/needs to meet customer, site, and corporate objectives. 
• Works with Manager to establish and ensure achievement of unit’s customer service, utilization patterns, productivity, quality, and financial goals
• Supports all corporate and/or national quality/certification initiatives (i.e. URAC)
• Communicates and manages staff to QA and/or productivity standards, as applicable.
• Supports Manager, Corporate, and Sales/Client Services in evaluating customer's service, utilization patterns, quality and financial results to assure that service delivery is within parameters defined by product and underwriting model.
• Acts in account management and performs active customer service function for account(s); provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instructions or procedures that must be followed by Inpatient Case Management team.

Minimum requirements:

Ideal Candidate must reside in California

• Current active unrestricted California Registered Nurse. Must have (RN) license in state where you reside.
• 3 years’ experience in case management or utilization review. 

Preferred requirements:

• Bachelors/CCM preferred
• Previous management experience
• Demonstrated ability to assist with sales/training/account service management
• Experience in training and staff development
• Excellent communication, interpersonal, and analytical skills
• Acquired knowledge of benefit plan design and customer needs
• Excellent time management, organizational, research and negotiation skills
• Knowledge of the insurance industry and claims processing
• Service marketing/sales experience a plus
• Ability to use basic document, spreadsheet, internet, email applications, and basic computer skills
• Ability to work in a fast-pace and changing business environment
• Ability to build solid working relationships with staff, customers, or providers
• Demonstrated process improvement experience

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provide