Cigna Medicare Population Health Transplant Care Manager Senior Analyst

This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury. The Case Manager will 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 based on business perspectives. The Case Manager will 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. IN addition to Case Management duties, the Case Manager will manage precert and concurrent reviews for the transplant members assigned to their caseload. This will require review of clinical information and correspondence with facilities to make determinations on transplant requests.

Major responsibilities and desired results:

• Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.
• Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and current status and to 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 and unrestricted Registered Nurse (RN) license in state or territory of the United States
• Two years full-time equivalent of direct clinical care to the consumer
• Case Management exp strongly preferred
• Medicare experience strongly preferred
• CCM Certification preferred
• Requires high speed broadband wired internet with a modem. Cannot support hot spots or satellite-based internet for this role

Preferred requirements:

• Within three (3) years of hire as a case manager, the case manager will become CCM certified.

Competencies preferred :

• 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
• Perform precert and concurrent reviews for transplant members
• Collaborate with Facilities and Health Care Providers telephonically to obtain clinical information
• Manage own caseload and coordinate all assigned cases.

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.

For this position, we anticipate offering an annual salary of 68,700 - 114,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

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-bein