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(RN) Oncology Nurse Case Manager(Pittsburgh,PA- Robinson Office Location)

Job typeFull Time
CountryUnited States
Job Description
This is a permanent work at home position

Monday-Friday. Must be flexible on hours and work one day a week until 7 p.m. based on your time zone

Summary Description of Position

Manages a caseload of specialty cases, evaluating the need for alternative services and as appropriate; assesses, plans implements, coordinates, monitors, and evaluates options and services to meet an individual's healthcare needs. Through communication and available resources, the Specialty Case Manager promotes quality case effective outcomes, and provides quality, cost effective alternatives to acute care. As an owner of cases with onsite needs, the Specialty Case Manager performs clinical review of services and coordinates all discharge planning needs.

Major Job Responsibilities and Required Results

Obtains informed verbal consent and takes all steps to obtain written consent.

Establishes a collaborative relationship with the client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care.

Sets a plan for short term and long term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure.

Implements, coordinates, monitors and evaluates the case management plan on an ongoing basis in collaboration with the client and treating providers as appropriate.

Negotiates fee for services, level of care, intensity and duration with providers(s), as able.

Documents findings in a clear concise manner and continues to evaluate medical necessity of frequency, intensity and length of care with physician(s) and agency/vendor(s) on an ongoing basis.

Acts as 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 quality assurance standards and all case management policy and procedures.

Delivers utilization review services for all inpatient, outpatient, and home services throughout the duration of transplant case management services. Interacts and coordinates referrals to the

Medical Directors as necessary.

Acts as a preceptor for Case Managers for training and/or performance issue, as able and as assigned.

Demonstrates evidence of continuing education, minimally 1 per quarter to maintain clinical expertise.

The Specialty Case Manager interacts with benefit specialist and claims staff for claim payment direction to ensure correct interpretation of transplant contracts and to apply payments accurately.

Assists in service marketing and/or account management functions for service center-based customers, as assigned.

Assists Sales Account Executive in communicating status and/or resolving issues for service center-based customers, as assigned. Participates on committees, task forces and other company projects, as assigned. Supports training initiatives or audits of case files, as assigned.

Demonstrates sensitivity to culturally diverse situations, clients and customers. Any other assigned tasks as deemed necessary to meet business needs.

Ensures the member's privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards.

Minimum Requirements

Active unrestricted Registered Nurse (RN) license required

Minimum of 3 years direct patient care experience required

Direct patient care experience within Oncology or Hospice required

Clinical experience in case management within Oncology or Hospice preferred

Demonstrated ability as a specialty case manager and ability to assist supervisor with sales/training/account service management.

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

Expert knowledge of the insurance industry and claims processing preferred

Service marketing/account management experience a plus.

Computer skills and typing expertise required

Must have access to broadband, wired internet with a modem

Cannot support hot spots or satellite-based internet

This role is WAH which allows work to be performed at home. Employees must be fully vaccinated if they choose to come onsite. Currently we are encouraging all employee to remain working from home and all onsite meetings require a virtual option. Are you willing and able to comply with our policy?

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.
Employer410 CIGNA Health Management Inc.