LPN/LVN or RN Nurse Case Management Senior Analyst- Work Onsite at Providers Office

1 month ago

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

Excited to grow your career?

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.

Primary Function: Coordinate and manage relationships with participating provider practices.

Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics.

Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources.

Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.

Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers.

Responsibilities:


• Identifies gaps in needed quality metrics for customers and communicates to provider


• Maintains physical presence in participating provider practices


• Identifies high-risk/high-cost patients for possible case management intervention.


• Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development.


• Identifies customer needs, coordinates and supports planned and unplanned transitions and post discharge follow up calls which may include primary care physician and specialist appointment scheduling


• Collaborates with the attending physician to achieve identified patient outcomes.


• Attend and participate in weekly Complete Health Team rounds


• Perform telephonic outreach or home visits, as needed


• Communicates with all departments to resolve issues or document trends.


• Understands and follows administrative guidelines (policy and procedure) of the unit.


• Attends and actively participates in staff meetings.


• Other Duties as assigned. Supervisory Responsibilities:


• None

Ideal candidate must be available to work onsite at providers office.

Experience:


• Current Licensure as a Registered Nurse, in the state of Alabama in good standing.


• Associates degree, diploma or B.S. in Nursing


• Three to Five (3-5) years recent experience in an acute-care environment, case-management or utilization management position (experience can be a combination of LVN/RN licensure)


• Previous HEDIS and/or CMS STARs experience a plus

Job Related Skills:

Verbal and written communication skills


• Interpersonal skills


• Basic Mathematical and statistical ability


• Organizational skills


• Typing and computer knowledge- able to type 35WPM


• Knowledge of utilization review requirements and procedures


• Knowledge of current health care practices and appropriate treatments.


• Knowledge of community resources


• Ability to travel to and work at participating provider offices


• Works independently with minimum of supervision


• Bilingual – preferred Spanish both conversational and written


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.

  • Licensed Practical Nurse

    2 weeks ago

    Birmingham, Alabama, United States Diversicare Healthcare Services & Diversicare Ther Full time

    OverviewAt Diversicare Healthcare Services & Diversicare Ther, we value our nursing team members and provide opportunities for growth and career advancement in a dynamic and supportive environment.Our MissionWe prioritize the growth and development of our valued nursing team members, recognizing their pivotal role in delivering outstanding healthcare...

  • Licensed Practical Nurse

    2 weeks ago

    Birmingham, Alabama, United States Diversicare Healthcare Services & Diversicare Ther Full time

    OverviewDiversicare Healthcare Services & Diversicare Ther values its nursing team members and provides opportunities for growth and career advancement in a supportive team environment.Our MissionWe prioritize the growth and development of our valued nursing team members, who play a pivotal role in our mission to deliver outstanding healthcare services that...

  • Local RN Case Manager Position

    2 weeks ago

    Birmingham, Alabama, United States Trusted Resource Associates (TRA) Full time

    Position OverviewTrusted Resource Associates (TRA) is currently seeking a local contract Registered Nurse (RN) specializing in Case Management for a nursing role in Birmingham, Alabama.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: Local ContractWeekly Hours: 40 hoursShift: 8 hours, daysContract Duration: 13 weeksThe RN Case Manager will...

  • Senior Office Administrator

    1 week ago

    Birmingham, Alabama, United States Department for Work and Pensions Full time

    Position OverviewAre you ready to join a dynamic and forward-thinking team that is instrumental in transforming the administration of public services? We are seeking individuals who are adaptable, insightful, and capable of managing high volumes of tasks with efficiency and precision.An exciting opportunity has arisen within the Synergy Initiative, a...

  • Licensed Practical Nurse

    3 days ago

    Birmingham, Alabama, United States Diversicare Healthcare Services & Diversicare Ther Full time

    About Diversicare Healthcare Services & Diversicare TherWe value our nursing team members and provide opportunities for growth and career advancement.Why Choose Diversicare?Clinical Career Advancement: Elevate your clinical leadership skills with our Clinical Career Ladder, offering progression opportunities to roles like LPN Charge Nurse, LPN Nurse...

  • Senior Analytics Consultant

    2 weeks ago

    Birmingham, Alabama, United States Cabinet Office Full time

    Position OverviewThe Government Commercial and Grants Services (GCGS) division operates within two primary Government Functions: the Commercial Function (GCF) and the Grants Management Function (GGMF). Our mission is to provide top-tier digital, data, and analytical solutions that enhance service delivery through innovative technology and data-driven...

  • Licensed Practical Nurse

    4 days ago

    Birmingham, Alabama, United States Diversicare Healthcare Services & Diversicare Ther Full time

    Overview About Diversicare Healthcare Services & Diversicare Ther Diversicare Healthcare Services & Diversicare Ther values its nursing team members and provides opportunities for growth and career advancement in the healthcare industry. Why Choose Diversicare Healthcare Services & Diversicare Ther? Clinical Career Advancement: Elevate your clinical...

  • Travel LPN Position

    2 weeks ago

    Birmingham, Alabama, United States RTG Medical-LTC Full time

    Job DetailsRTG Medical-LTC is seeking a skilled LPN/LVN for a travel nursing position.Job RequirementsSpecialty: LPN/LVNDiscipline: LPN/LVNShift: 12 hours, nightsHours per week: 36Duration: 13 weeksEmployment Type: TravelAs a travel LPN/LVN, you will have the opportunity to work in a dynamic and challenging environment, providing high-quality patient care...

  • Medical-Surgical LVN Position Available

    1 week ago

    Birmingham, Alabama, United States Supplemental Health Care Full time

    We are seeking a Travel Med Surg LVN/LPN for an exciting opportunity with a reputable healthcare provider.This position offers a competitive pay structure for 36 hours a week over a 13-week duration. With our platform, you can compare salary rates from top agencies across the nation.Here are the specifics of this Travel LVN/LPN position:Specialty: Med Surg...

  • Travel Nurse RN Case Manager

    5 days ago

    Birmingham, Alabama, United States Trusted Resource Associates (TRA) Full time

    Job Title: Travel Nurse RN Case ManagerJob Summary:Trusted Resource Associates (TRA) is seeking a skilled Travel Nurse RN Case Manager to join our team. As a Travel Nurse RN Case Manager, you will play a critical role in facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and...

  • Surgical Center LPN

    2 weeks ago

    Birmingham, Alabama, United States Amergis Full time

    About Amergis:Amergis, previously known as Maxim Healthcare Staffing, has been dedicated to connecting individuals with meaningful employment opportunities since 1988. We focus on delivering exceptional staffing solutions for healthcare and educational professionals across various settings.Position Overview:A career at Amergis involves being part of a...

  • LPN/LVN - Medical Surgical Unit

    5 days ago

    Birmingham, Alabama, United States Ascension Full time

    Job SummaryWe are seeking a skilled LPN/LVN to join our Medical Surgical Unit at Ascension St. Vincent's Birmingham. As a key member of our healthcare team, you will provide high-quality patient care under the direction of a registered nurse or physician.ResponsibilitiesContribute to the assessment of patients and ensure their well-being.Administer...

  • Travel LPN

    1 week ago

    Birmingham, Alabama, United States Nurses First Solutions Full time

    Job SummaryNurses First Solutions is seeking a skilled LPN/LVN to fill a Med Surg position in a travel assignment. As a key member of the healthcare team, the successful candidate will provide high-quality patient care and work collaboratively with other professionals to achieve optimal patient outcomes.ResponsibilitiesAdminister medications and treatments...

  • RN Case Manager I

    1 day ago

    Birmingham, Alabama, United States Princeton Medical Center Full time

    Job Summary:The RN Case Manager I is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to self-determination.Key Responsibilities:Accurate medical necessity screening and...

  • Skilled Nursing Care Provider

    7 days ago

    Birmingham, Alabama, United States Right at Home Birmingham Full time

    Job SummaryRight at Home Birmingham is seeking a skilled Registered Nurse to join our team as a Home Health Nurse - PRN. As a Registered Nurse, you will be responsible for providing high-quality patient care in the comfort of their own homes.Key ResponsibilitiesCase Management: Develop and implement individualized care plans that meet the unique needs of...

  • RN Case Manager I

    3 days ago

    Birmingham, Alabama, United States Princeton Medical Center Full time

    Job SummaryThe RN Case Manager is a key member of the healthcare team at Princeton Medical Center, responsible for coordinating patient care and ensuring optimal health outcomes. This role requires strong clinical expertise, effective communication skills, and a commitment to delivering high-quality patient care.Key Responsibilities:Conduct thorough...

  • LPN Travel Nurse

    1 week ago

    Birmingham, Alabama, United States Nurses First Solutions Full time

    Job SummaryNurses First Solutions is seeking a highly skilled LPN/LVN to join our team as a Medical Surgical Nurse for a travel assignment in a dynamic healthcare setting.Key ResponsibilitiesProvide high-quality patient care under the supervision of registered nurses and physicians.Administer medications and treatments as prescribed by physicians, monitoring...

  • Senior Financial Analyst

    2 weeks ago

    Birmingham, Alabama, United States Vaco Full time

    Join a Leading Firm as a Senior Financial AnalystOne of the most reputable companies in the region is seeking a Senior Financial Analyst to become part of their expanding team. This role offers a collaborative work environment, an extensive benefits package including performance-based bonuses, and a culture that prioritizes employee well-being and...

  • Local Contract Nurse RN Case Manager

    3 days ago

    Birmingham, Alabama, United States Trusted Resource Associates (TRA) Full time

    Job Title: Local Contract Nurse RN Case ManagerJob Summary:Trusted Resource Associates (TRA) is seeking a skilled Local Contract Nurse RN Case Manager to join our team. As a Case Manager, you will play a vital role in facilitating care along a continuum, ensuring patients receive optimal health, access to care, and appropriate utilization of...

  • Surgical Center LPN

    2 weeks ago

    Birmingham, Alabama, United States Amergis Full time

    A career with Amergis offers the opportunity to be part of a vibrant and energetic healthcare environment, where each team member plays a vital role in transforming lives. We are dedicated to our mission, and it reflects in our work. As a leader in personalized body transformation, we believe everyone should have the chance to achieve their ideal self and...