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Nurse (RN) Case Management Lead Analyst-MST

Job typeFull Time
CountryUnited States
Summary Description and Responsibilities

Hours: 8 a.m.-5 p.m. AZ time. Must be able to work these hours based on AZ time zone

This position, the Case Management Lead Analyst, 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 environment.
  • Manages/coordinates an active caseload of case management cases for Cigna Medicare.
  • Uses clinical knowledge to assess the treatment plan and goals, and identifies gaps in care or risks for readmission or complications.
  • Establishes patient centric goals and interventions to meet the member's needs
  • Interfaces with the member, family members/caregivers, and the healthcare team, and embedded care coordinator as well as internal matrix partners.
  • Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers

Major responsibilities and desired results:
  • 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.
  • Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
  • 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

  • Unencumbered AZ /Multistate Registered Nurse licensure with a minimum of 2 years of experience in utilization management, Case Management, Care Coordination or related area
  • Case Management experience required
  • Medicare exp preferred
  • Diabetic education experience a plus
  • Prefer candidates located in AZ but will consider qualified candidates from other states as well, as long as they are willing to work Arizona hours and have a compact RN licensure
  • Computer and Microsoft application proficiency
  • Population Health Management experience that has resulted in appropriate utilization of services and knowledge of community services preferred
  • Strong oral, written, and presentation skills required in order to represent the organization to internal and external customers

Critical Behaviors
  • Exceptional written and verbal communication skills that demonstrate Cigna Health Plan of Arizona's commitment to superior customer service and quality of care and shows concern for each and every internal and external customer
  • Communicates effectively well with diverse audiences that include non-licensed and highly-licensed individuals, medical directors and senior leaders within Cigna and external organizations.
  • Acts politely but is willing to have difficult conversations and is able to hold his/her ground in challenging situations
  • Maintains patient confidentiality at all times
  • Passionate about decreasing unnecessary healthcare utilization and improved financial performance
  • Exhibits ownership of processes and projects and relentlessly drives for excellent results
  • Takes full ownership of the processes needed to reduce utilization and for the overall results of initiatives within his/her responsibility

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.
Employer702 CIGNA HealthCare of AZ, Inc.