Cigna Medicare Population Health Nurse Case Management Senior Analyst

Job Description Summary

Delivers specific delegated tasks assigned by a supervisor in the Case Management job family. Handles moderately-complex cases. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Evaluates, recommends, and maintains close relationship with inpatient and outpatient counseling/treatment facilities.

Evaluates employee counseling and treatment needs and makes recommendation on changes or additions to appropriate programs. Manages own caseload and coordinates all assigned cases. Completes day-to-day Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. May require a Master's Degree in a health care related field with current licensure.

Job Description

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.  

Responsibilities:

• 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.
• Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.
• 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.
• Ideal candidate would have 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 wo