RN Integrated Care Coordinator - Case Management Lead Analyst- Evernorth- Carlsbad, New Mexico

RN Care Coordinator - Carlsbad NM

The goal of the RN Care Coordinator role is to improve care delivery of the aligned population through identification of risk and opportunity, collaboration and coordination with clinical and administrative partners, and promotion of available programs.      

This role is to be an embedded clinical liaison and resource to employer, health center staff, customer population, programs, services, and matrix partners to identify and coordinate customer care. Some actions the RN CC may take, but are not limited to are the following:

• Works with health center staff to Identify and refer appropriate customers to eligible programs within Cigna Healthcare (CHC) and all eligible client specific health and wellness programs.

• Supports Care Coordination of the individual customer. Coordinates the care of the high-risk targeted population in an appropriate, efficient, high-quality and cost-effective manner. Refers to appropriate clinical partners (i.e. complex case management and / or Specialty Case management)

• Partners, and functions as central conduit among employer, provider (e.g., Primary Care Provider, Onsite Health Center Clinician) and all available Cigna programs and resources.

• Supports established process and procedures that ensures thorough review of patient level actionable data and reports used to support identification of customers for outreach and engagement.

• Assure and maintains timely, compliant, efficient documentation and information exchange to drive appropriate outreach, engagement and positive clinical outcomes with aligned population.

• Communicates clearly with all matrix partners, and refers to appropriate internal and external programs to support outcomes.

• Identifies cases appropriate for complex case management and follows process for referral.

• Works effectively with Cigna’s internal team to support coordination of care and data analysis.

• Identifies and builds effective relationships with local network providers. Provides steerage to high quality network providers and referrals to the onsite health center.

• Identifies gaps in care and works with providers and/ or local community resources to close gaps in care.

• Establishes and maintains a positive, professional, and collaborative relationship with customer/employee, employer, providers of care, and Cigna partners to support improved outcomes (clinical, quality and cost) of aligned employee population.

• Partners and coordinates with health management matrix partners for additional engagement and promotion opportunities

• Acts as resource to direct customers with specific non-clinical questions to the appropriate resource.

Qualifications
 

• RN with current unrestricted state licensure required with three or more years of clinical practice experience

• Case Management experience is preferred

• A high energy level with excellent oral and written communication skills.

• Excellent Computer skills [specific software e.g. Word and Excel]

• Excellent interpersonal skills. Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly.

• Comfortable communicating with multiple clinical partners (direct care, Direct Health, and telephonic coaching and case management teams).

• Clinical Expertise in one or more of the following areas desired: Musculoskeletal, Metabolic/Diabetes, Oncology, Maternity/Fertility, Mental Health)

• Experience in project development and working in a matrix environment preferred.

• Self-directness and the ability succeed in an independent role.

• Passion for assisting member with health improvement and navigation of the Health Care System.  Must have strong problem solving skills

• Bilingual English / Spanish preferred

This is a 40 hour a week role, working 4 - 10 hour days, including some early mornings.

This position is based onsite in Carlsbad NM.

Cigna is committed to a healthy work force. New hires must complete a background check, drug and nicotine screen to be employed in this role.

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.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality.