Case Management Lead Analyst (Global Maternity)
This position through the case management process will promote the improvement of health outcomes to members and assist those members experiencing illness, injury and specifically during the ante natal period. The Clinical 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 Clinical Case Manager will provide customers and clients with assistance to include " Information, Navigation and Coordination" to best meet the customers medical needs with regards to the covered benefit plan. Assistance may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans .Responsibilities
- Manages/coordinates an active caseload of case management cases by providing Information, Navigation and Coordination primarily Maternity Customers.
- Uses clinical knowledge and communication skills to provide navigation, education and support to Maternity members and identifies risks, gaps in care and potential for complications.
- Education around the best practices for pre-conception through to all stage of ante-care care and post-partum.
- Establishes patient centric goals and interventions to meet the member's needs
- Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
- Balances business needs with patient advocacy
- Build solid working relationships with Client HR team, internal staff, matrix partners, key functional areas, customers, and providers
- 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
- 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.
- Provide international customer base with " assistance " support including; "Information, Navigation and Coordination" through customer advocacy, provider identification, assistance with health care coordination and healthcare navigation though use of internal resources and global clinical team.
- 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.
- Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.
- Demonstrates sensitivity to culturally diverse situations, clients and customers.
- Background in nursing. Foreign Medical Graduate, Licensed Practical Nurse, Registered Nurses are all qualified. Nurse licensure in the United States is not required.
- Experience and knowledge of utilization or case management, cost containment services, managed care, insurance coverage, and financial management.
- Language skills: English and a second language required.
- Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.
- Strong interpersonal and communication skills.
- Demonstrates problem-solving and analytical skills.
- Ability to operate personal computer, proficient with Microsoft office products and call center software
This position is not eligible to be performed in Colorado.About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
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.