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RN Embedded Care Coordinator/Nurse Case Management Sr Analyst - Colorado, Denver, Colorado

Job typeFull Time
CountryUnited States
*This role is in Colorado and covers North and South Colorado*

Summary: Coordinates and manages member care related to preventative health following HEDIS guidelines, with single office practices and/or multiple provider practices in the Cigna Medicare plan. Responsible for providing support to members, their families, and physicians in addressing medical and social concerns. Educates members to make informed personal health care decisions. Supports key matrix partners in performing strategies to improve Star quality performance. Facilitates communication between member, physician, health plan, and community to effectively improve Star performance.

Coordinate and manage member care in participating provider practices:
Under general supervision, responsible for identifying medium/ high risk members by utilizing predictive modeling reports for the assigned physician and/or practice.

Identify gaps in care and document compliance. Initiate contact with member/family, physician, and health care providers/suppliers to discuss the alternative treatment plans.

Greet members at on-site visits and assess members that need an ECC visit to assure coordination where possible.

Perform telephonic outreach to member in need of care coordination and for outreach campaigns as needed. Monitors and evaluates inpatient admissions and discharge census and follows through for post discharge appointments and needs.

Partner with in-office Point-of-Contact(s) to ensure member compliance and practice success:

Coordinate real-time performance measure management by communicating any updates to member health care.

Ensure that participating practices are driving improvement on Star performance measures.

Review data for those members that are frequent users of healthcare resources to ensure they are receiving the proper care.

Develop and maintain a process to ensure that all members in participating practices receive the screenings and services needed within the given timeframe.

Maintain detailed understanding of P4Q Program and HEDIS/STAR performance measures.

Once permitted, role will travel to doctor's offices. The role will also work a portion of the week from home. Requires wired-broadband high-speed internet.

Minimum Requirements: Active and Unencumbered Colorado RN licensure. At least 3-5 years of related experience in a doctor's office or managed -care setting. Excellent written and oral communication skills; excellent problem solving skills; highly organized and proactive; ability to handle multiple tasks and set priorities; detailed oriented; works independently with minimal supervision. Must be able to effectively navigate multiple systems and be technically savvy. Ability to travel to and work at participating practices in North and South Colorado. Must reside in or near Metro Denver, Colorado area. Requires wired-broadband high-speed internet.

Preferred Requirements: Minimum five years clinical practice experience in a providers' office, hospital setting. Experience working with Microsoft office applications, electronic medical records and similar databases strongly preferred. Knowledge of STARS and HEDIS guidelines.

For this position in Colorado, we anticipate offering an annual salary of 60,700.00, +/- 20%, depending on experience.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we'll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the "Life at Cigna" tab on our careersite: www.cigna.com/careers

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.
Employer828 Newquest LLC

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