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Nurse Case Management Manager

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Tempe, United States The Cigna Group Full time

Evernorth Care Group (ENCG) is a leader in integrated primary care and an industry pioneer in value-based care. We focus on providing high-quality, affordable and accessible care for our patients across Arizona.

The Care Management team works closely with the primary care team to support patients through their healthcare journey. The team works hand in hand with primary care providers to ensure the patient is cared for beyond the clinic walls. This position is a key partner implementing population health and care management capabilities across a network of primary care medical clinics. The goal of this work is to make care more affordable for ENCG’s patient population through the execution of best practice clinical programs that provide patient-centered care and improve the overall health of the patient population.

Through oversight, influence, and relationship-building, this role will ensure the implementation of consistent practices, processes, and protocols to achieve excellence in quality of care, service, resource utilization, employee/physician satisfaction, and workplace safety. This position will utilize data, sound operational processes, and shared goals to improve the performance of the care group and will effectively collaborate with Care Delivery and external partners.

The Care Management Manager executes initiatives for the Care Management team to improve operational effectiveness and financial outcomes. This position will oversee licensed and non-licensed staff working with vulnerable populations and offering holistic care management, care coordination, and disease management support to customers and physician practices located throughout the Phoenix metro area.

Critical to this position is the ability to promote an innovative and inclusive culture, with a primary focus on enabling support staff to embrace the ENCG strategy of promoting quality care and providing efficient services in a customer centric manner. Additionally, this position collaborates with the Quality Clinical Program Senior Manager to ensure all requirements of value-based and core contracts are met through the implementation of population health-based initiatives and programs.

Hours: Monday - Friday 8am - 5pm (flexibility with exact hours) Must live in Arizona

Reports to : Clinical Program Director

Direct Reports : Care Management RNs, Care Navigators and Social Workers

Responsibilities and Essential Functions

  • Accountable for directing case management activities and developing strategies to control the costs of high-risk, high-cost cases by mitigating hospital admissions, readmits, ED utilization and working closely with clinicians to meet MLR, ADK and EDK metrics.

  • Identify cost-effective protocols and initiatives for high-risk, high-cost diagnoses; and, developing and administering guidelines for working with employees, employers, policyholders, healthcare providers, patients, and families to determine appropriate, cost-effective care plans.

  • Ensures quality patient care by Care Management staff through transitional care management, care planning, chronic disease management, targeted outreach initiatives, and connections to community resources.

  • Responsible for the strategic and operational leadership of ENCG Population Health efforts. This role will partner with VBC lead to create and execute on strategy to deliver on care co-ordination performance metrics on VBC contracts. Collaborate as a thought leader in developing and/or improving clinical strategy that enables stronger coordination of care, affordability, customer/clinician experience and transparency.

  • Ensures the Care Management team coordinates care between the primary care physician, community resources, family and patient.

  • Provides direct and remote oversight of staff and assures achievement of individual and team performance and productivity standards; monitors work product and division of work between team members to promote staff working at the top of their licensure.

  • Monitors and analyzes routine and ad hoc reports, case loads, and care coordination management efforts for the team; routinely rounds on staff to communicate key messages and identify concerns and issues.

  • Manage and execute Care Management programs (Transitions of Care, Chronic Disease Management – such as diabetes); ensure consistent, efficient and cost-effective processes, procedures and appropriate accountability.

  • Participates in joint operating committee meetings with health plans. Meets value-based contract metrics and outcomes as determined by ENCG contracted health plans, CMS, State of Arizona (AHCCCS) and contractual obligations for commercial customers.

  • Partner with clinical and operational leadership to align initiatives and prioritize interventions for greatest impact; properly utilize technology to standardize assessments, workflows, and care planning to build initiatives to scale.

  • Drive the development and practice implementation of population health initiatives and continue optimizing as needed to achieve the desired clinical and business outcomes.

  • Facilitate dissemination of best practices and development of new tools to support standardization of roles and more effective outputs.

  • Directly responsible for personnel actions including hiring, training, coaching, evaluating performance, monitoring time and attendance, and scheduling of team members.

  • Provide constructive feedback and effectively manage conflict within the Care Management team. Ensure patient and provider satisfaction with Care Management services and demonstrates service recovery when needed.

  • Promotes effective communication between Care Management and other ENCG departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision of services; fosters and maintains collaborative relationships within the clinician practices, hospitals and external agencies related to quality performance and day-to-day issues that may arise.

  • Leads the team effectively through change; regularly and proactively communicating with team leads and staff regarding impending external and internal change. Include other impacted staff whenever possible in designing solutions to effectively navigate change.

  • Perform all other duties and special projects as needed to support the overarching goals of the Care Management team and/or key business unit partners.

Skills & Competencies

  • Clinical expertise with a mindset and focus on achieving results with and through others

  • A talent for balancing critical thinking with hands-on execution to successfully implement strategies within team to accomplish organizational goals

  • The ability to validate data directly tied to population health and value-based care

  • The ability to effectively performance manage, coach, and develop staff

  • Excellent presentation, interpersonal and relationship-building skills

  • Personal influence and credibility with clinical staff, non-clinical staff, clinicians and ENCG leadership

  • Excellence in customer service, service recovery, and complaint resolution skills

  • The ability to lead and manage interdisciplinary teams including nurses, care navigators/community health workers and social workers

Core Competencies

  • Drives Results: Consistently achieving results, even under tough circumstances

  • Manages Complexity: Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.

  • Communicates: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.

  • Being Resilient: Rebounding from setbacks and adversity when facing difficult situations.

  • Manages Ambiguity: Operating effectively, even when things are not certain or the way forward is not clear.

  • Optimizes Work Processes: Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.

  • Builds Networks: Effectively building formal and informal relationship networks inside and outside the organization.

  • Situational Adaptability: Adapting approach and demeanor in real time to match the shifting demands of different situations.

Qualifications

  • RN with current Arizona license

  • Master's Degree in health care related field preferred

  • Minimum three (3) years of supervisory or management experience as a director, manager, supervisor or other leadership role, such as lead or program/project management experience or related consulting experience where responsibilities would include managing teams of people, timelines, budget, etc.

  • Minimum of five (5) years related clinical experience, preferably in value-based care, population health, ambulatory care, community public health, case or care management, or coordinating care across multiple settings and with multiple providers.

  • Proficiency with Microsoft Excel, PowerPoint, and Word

  • Experience with EPIC Electronic Health Record and Tableau preferred

  • Certification in related field (Ex: Certified Case Management, Six Sigma, Project Management) preferred

  • Case Management/Care Coordination/Disease Management experience required

  • Excellent oral and written communication skills

  • Experience with cross-functional team collaborations, workflows, and process improvement

  • Bilingual (Spanish) preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

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.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.