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to Nurse Case Management Lead Analyst

3 months ago

Nashville, Tennessee, United States The Cigna Group Full time
The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

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We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

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
  • Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
  • Performs leadership role on team when implementing new tools or case management programs/initiatives.
  • Manages own caseload and coordinates all assigned cases.
  • Supports and provides direction to more junior professionals.
  • Works autonomously, only requiring "expert" level technical support from others
  • Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required.

Summary description of position:

This position, the Nurse Case Manager 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. 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. The Case Manager will be responsible for meeting all Medicare and DSNP model of care requirements. They will have the ability to work independently and effectively communicate to internal and external customers in a telephonic environment. The case management team lead will serve as resource and collaborator on difficult cases and serves as a mentor for new hires and junior staff.

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.

Work schedule:

Monday to Friday 8:00 AM-5:00 PM

Minimum requirements:

Active, unrestricted Registered Nurse (RN) Multi-State License. Must be willing to get licensed in non-Compact states as required by the business. Two years full-time equivalent of direct clinical care to the consumer

Preferred requirements:

  • Experience in training and staff development
  • Excellent communication, interpersonal, and analytical skills
  • Excellent time management, organizational, research and negotiation skills
  • Knowledge of the insurance industry and claims processing
  • Ability to use basic document, spreadsheet, internet, email applications, and basic computer skills
  • Ability to work in a fast-pace and changing business environment
  • Ability to build solid working relationships with staff, customers, or providers
  • Demonstrated process improvement experience

Competencies:

  • 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

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.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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.