Cigna Medicare Clinical Operations Population Health SNP RN Case Manager

Job Description

For this position, Nurse Case Manager Senior Analyst, through the case management process, will:

• Promote the improvement of health outcomes to members.
• Assist those members experiencing the burdens of illness and injury.
• Assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population.
• Promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
• Ability to work independently and effectively communicate to internal and external customers in a telephonic environment. 
• Hours: Monday - Friday, 8 am - 5 pm in candidate's own time zone.

Responsibilities:

• Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
• Promote consumerism through education and health advocacy.
• Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
• Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
• Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Demonstrates sensitivity to culturally diverse situations, clients and customers.

Minimum requirements:

• Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license a plus.
• Two years full-time equivalent of direct clinical care to the consumer.
• Previous case management experience with the Medicare/Medicaid population specifically focusing on Special Needs Plan. Model of Care documentation requirements, care coordination working with hospital settings and Primary Care Physician offices.
• Knowledge of community resources is also helpful.
• Excellent verbal and written communication and interpersonal skills
• Ability to learn new processes and systems quickly.
• Strong time management and organization skills.
• Ability to prioritize the work.
• Strong research and analytical and problem-solving skills.
• Ability to work independently.
• Knowledge of managed care preferred.
• Effective coaching/education skills
• Ability to work in rapidly changing environment.
• Experience Senior population Chronic conditions
• Ability to work with people with significant educational and or socioeconomic barriers impacting their health Education.

Preferred requirements:

• Within three (3) years of hire as a case manager, the case manager will become CCM certified.
• Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills.
• Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
• Strong skills in the following areas:  teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making.
• Experience in medical management and case management in a managed care setting is highly desirable.
• Knowledge of managed care products and strategies
• Demonstrated sensitivity to culturally diverse situations, participants, and customers.
• This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.
• 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 provider with speeds of at least 10Mbps download/5Mbps upload.

Benefits:

• We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) w