Float Pool (RN) Case Management Lead Analyst - Evernorth Health Services - Remote

Premium Solutions Float Pool Nurse Case Management Lead Analyst

This is a full-time Telephonic/Digital RN Case Manager role.  Must be flexible to work an 8-hour shift between 9:00 a.m.-9:00 p.m.​​

Major Job Responsibilities and Required Results for Float Pool CM:

• • Obtains informed verbal consent and takes all steps to obtain written consent.

  • Acts with speed and purpose to identify, support and resolve customer healthcare needs.

  • Establishes a collaborative relationship with the Customer, client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care.

  • Sets a plan for short-term and long-term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure.

  • Promotes quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and consumerism approach through education and health advocacy to our customers

  • Implements, coordinates, monitors and evaluates the case management plan as appropriate.

  • Documents findings in a clear, concise, and accurate manner.

  • Acts as liaison between account, client/family, physician(s) and facilities/agencies.

  • Builds solid working relationships with internal team members and across Picerno organization.

  • Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.

  • Adheres to quality assurance standards and all case management policy and procedures.

  • Demonstrates sensitivity to culturally diverse situations, clients and customers. Any other assigned tasks as deemed necessary to meet business needs.

  • Ensures the member’s privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards.

  • Based on experience, may provide leadership, preceptor/mentorship, support and coverage to other case management staff and assist case managers in achieving positive outcomes and savings

  • Complies with all accreditation, State and Federal mandates.

  • Completes training as required per role and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate

  • Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

  Additional Roles and Responsibilities Specific to Float Pool CM Role:

  • Will manage a large volume of outbound calls, are required to be available during all scheduled times, and manage calls and after call work in a timely manner.

  • Must like fast paced work, be able to thinking critically and demonstrate system proficiency.

  • Must be a high performing CM with engagement rates at or above goal.

  • Will be responsible for identifying and addressing any immediate customer concerns, researching and providing solutions when possible along with assessing customer for ongoing complex case management needs and assigning to a client based CM for further management when appropriate.

  • Must be skilled in utilization of Cigna resources when identifying need for further customer support.

  • Be organized, knowledgeable and thorough while promoting quality case effective outcomes, and provides quality, cost effective alternatives to acute care.

  • Self-motivated and able to work autonomously

  • Consistent Use of “Grocery List” established and used on ongoing cases

  • Must meet/ exceed all PMD metrics.  tNPS >70%- as applicable to the aligned CM

  • Quality scores of >90% overall, Clinical Acumen =>80%

  • Clean SWAT Reports

  • Applies savings to cases in real time.

  • Comply with URAC touch rate of every 30 days.

  • Consistently addresses & completes CMA feedback.

  • Have a history of effective case load management.

  Minimum Requirements: 

  • Active unrestricted Registered Nurse (RN) license required in State of Residence

  • Internal position to Cigna CMs requires high-performing candidate