NOTE: This role will be work at home until the COVID 19 bans are lifted and it is safe to return to an office environment. After the pandemic this role will be office based in Plano, TX.
Shift for this role is either Monday- Friday 9:00 am- 5:30 pm OR 10:00 am - 6:30 pm.
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.
- Negotiates price, level of care, intensity and duration with provider(s), as appropriate.
- Acts as a timely and proactive liaison between account, client/family, physician(s) and facilities/agencies
- Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
- Compliant with all accreditation, State and Federal mandates
- Delivers utilization review services when member is in active case management as appropriate
- 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.
- 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
- Engage our CAC partner (Embedded Care Coordinator) to support service to our customers.
- Participates in committees, task forces and other company projects as assigned and other assigned tasks as deemed necessary to meet business needs.
- Other duties as required and related to this role
Active unrestricted Registered Nurse (RN) license in state or territory of the United States
Three years full-time equivalent of direct clinical care to the consumer required
MUST live in or near Plano, TX
Competencies preferred :
- Clinical experience in acute care, or a clinical setting, or case management including experience/expertise in one of the following selected fields of nursing: Intensive Care / Obstetrics/ Cancer Care / Rehabilitation / Coronary Care / Neurology / Trauma / Neonatology / Respiratory Care / Transplant Dialysis / Medical-Surgical/ Home Health / Hospice/Pediatrics
- Within four (4) years of hire as a case manager, the case manager will possess a URAC-recognized certification in case management.
- 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
- Knowledge of the insurance industry and claims processing
- Service marketing/sales and business acumen experience a plus
- 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
- Ability to work within changing business environment and balance business needs with patient advocacy
- Experience managing multiple projects in a fast paced matrix driven environment
- Demonstrated ability to coach and educate other case management staff
- Demonstrate effective organizational skills and flexibility to meet the business needs
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
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