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(RN) Nurse Case Manager- Day Shift

Job typeFull Time
CountryUnited States
(RN) Nurse Case Manager- Day Shift

NOTE: Due to Covid-19 restrictions, this is a temporary work at home position. Once social distancing restrictions are lifted, the employee may be required to transition to the in-office location.

The hours are Monday-Friday with hours 9 a.m. - 5:30 PM in your local time zone. Hours may shift due to business need.

Role Summary:

This position, the Nurse Case Manager, 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 or face to face environment.

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.
In conjunction with customer's providers, establishes a documented patient centric case management plan, identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
Implements, coordinates, monitors and evaluates the case management plan on an ongoing, appropriate basis.
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.
Drive efficiency and outcomes (including but not limited to engagement, retention, avoided readmissions, goal progress/achievement) through pre post process including queue management, call and assessment process
Compliant with all accreditation, State and Federal mandates
May conduct medical necessity review of select 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

Participates in committees, task forces and other company projects as assigned and other assigned tasks as deemed necessary to meet business needs.

Engage our CAC partner (Embedded Care Coordinator) to support service to our customers. Perform other related duties incidental to the work described herein.

Additionally the candidate will be responsible for the adoption and demonstration of the Consumer Health Engagement cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

Minimum requirements:

Active unrestricted Registered Nurse (RN) license in state or territory of residence of the United States

Eligibility to obtain additional state licensure based on business need as required by Cigna. Must be able to obtain a California RN licensure for this role.

Certification as a case manager preferred

Minimum of three years full-time direct clinical care to the consumer

Clinical experience in acute care required

Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills

Strong computer skills required

About Cigna

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 reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
Employer410 CIGNA Health Management Inc.

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