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Nurse Case Manager Senior Analyst

Created09/15/2021
Reference21007961
CategoryOperations
Job typeFull Time
CountryUnited States
Zip15689
SalaryCompetitive
Job Description
Position Scope:
  • 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

Summary description of position:

This position, the Nurse Case Manager Senior 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.

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. 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.

Minimum requirements:
  • Active and unrestricted Registered Nurse (RN) license in state or territory of the United States
  • Two years full-time equivalent of direct clinical care to the consumer
  • Case Management exp strongly preferred
  • Medicare experience strongly preferred
  • CCM Certification preferred
  • Requires high speed broadband wired internet with a modem. Cannot support hot spots or satellite-based internet for this role


Preferred requirements:
  • Within three (3) years of hire as a case manager, the case manager will become CCM certified.

Competencies preferred :
  • Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
  • Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
  • Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
  • Experience in medical management and case management in a managed care setting is highly desirable
  • Knowledge of managed care products and strategies
  • Demonstrated sensitivity to culturally diverse situations, participants and customers


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.
Employer828 Newquest LLC