The Cigna Group
Healthcare
NurseCaseManagerSeniorAnalyst
Neural analysis suggests this role is
optimal for Senior candidates.
“Nurse Case Manager Senior Analyst at The Cigna Group. Skills: Case management, Clinical assessment, Patient advocacy. Promote improvement of clinical outcomes. Assist members experiencing illness and injury”
What You'll Achieve.
Improve clinical outcomes; Achieve positive outcomes; Achieve savings
Industry & Context.
Problem-solving skills; Analytical skills
What They're Looking For.
Must Have
Nurse Licensure, MSc Nursing, Fluent reading, writing and speaking any additional language, Demonstrated organizational and leadership skills, interpersonal and communication skills, Demonstrates problem-solving and analytical skills, Ability to act as an “advocate” for the customer, Demonstrates sensitivity to culturally diverse situations, Compliant with all accreditations, State, Federal and local mandates, Ability to operate personal computer, Proficient with Microsoft office products, Proficient with call center software, Proficient with a variety of software, Not being under any warning
Nice to Have
Knowledge of utilization or case management, Knowledge of cost containment services, Knowledge of managed care, Knowledge of insurance coverage, Knowledge of financial management
What You'll Do.
Promote improvement of clinical outcomes
Assist members experiencing illness and injury
monitor and evaluate options
Provide customers and clients with assistance
Provide clinical information regarding medical conditions or treatments
Coordinate complex care plans
Promote quality cost-effective outcomes
Manage care needs through continuum of care
Utilize effective verbal and written communication skills
Educate members serviced
Advocate for members serviced
Manage/coordinate an active caseload
Assess the treatment plan and goals
Identify gaps in care or risks for readmission
Assess member’s health status and treatment plan
Identify any gaps or barriers to healthcare
Establish a documented patient centric case management plan
Interface with the member
family members/caregivers
Interface with internal matrix partners
Identify anticipated case results/outcomes
Identify criteria for case closure
Promote communication within all parties involved
Maintain accurate record of case management interventions
Evaluate medical information against criteria
Evaluate medical information against benefit plan
Evaluate medical information against coverage policies
Determine medical necessity
Build solid working relationships with internal staff
Build solid working relationships with matrix partners
Build solid working relationships with key functional areas
Build solid working relationships with customers
Build solid working relationships with providers
Provide leadership to other case management staff
Provide preceptor/mentorship to other case management staff
Provide support to other case management staff
Provide coverage to other case management staff
Assist case managers in achieving positive outcomes
Assist case managers in achieving savings
Assists Utilization Review
Participates in unit training initiatives
Participates in corporate training initiatives
Demonstrates evidence of continuing education
Adheres to professional practice within scope of licensure
Adheres to professional practice within scope of certification
Adheres to quality assurance standards
Adheres to all case management policy and procedures
How You'll Work.
Team & Collaboration
Internal staff; Matrix partners; Key functional areas; Customers; Providers; Healthcare team
Communication Scope
Verbal communication; Written communication
Full Job Description
**Summary description of position:** This position through the case management process will promote the improvement of clinical outcomes to members and assist those members experiencing illness and injury. 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. The Clinical 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 using different channels (videoconferencing and international phone calls) **Position Scope:** * Manages/coordinates an active caseload of case management cases by providing Information, Navigation and Coordination to Customers outside the United States. **Major responsibilities and desired results:** * Uses clinical knowledge to assess the treatment plan and goals and identifies gaps in care or risks for readmission or complications. * 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.) * Interfaces with the member, family members/caregivers, and the healthcare team/provider, as well as internal matrix part
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