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Cigna Medicare Population Health Nurse Case Management Senior Analyst
3 months ago
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.
Position Summary:
Plans, implements, and evaluates appropriate health care services to assist the customer throughout the continuum of care. Utilizes clinical skills to assess, coordinate, monitor and evaluate options and services in order to facilitate appropriate health care outcomes for customers. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
Maintains current knowledge of Cigna Healthcare Policies and Procedures, CMS requirements, State Medicaid requirements, NCQA standards and recommendations impacting care coordination, and Special Needs Plans Model of Care program goals and requirements, as applicable.
Essential Duties and Responsibilities:
- Outreach to customers for coordination of care and continuity of care management.
- Identify customer needs, coordinate and support planned and unplanned transitions, conduct post discharge follow up contact, which may include primary care physician and specialist appointment scheduling.
- Provide clinical assessments, health education, and utilization management to customers, as needed.
- Initiate contact with customer/caregiver/family, primary care physician, and health care providers/suppliers as needed. Conduct health risk assessments, which may include on-site evaluations (customer home visits) as needed.
- Develop and monitor customer's individualized plan of care, as well as communicate the plan of care to the customer and primary care physician. Prioritize case goals, monitor the completion of care goals and modify the individualized plan of care in the integrated care management system as needed.
- Document all encounters with the customer and practitioners and providers.
- Resolve any immediate issues for customers after screening but prior to routing for Case Management.
- Evaluate each case for quality of care, document and report quality issues to the appropriate team.
- Other duties as assigned.
Qualifications:
- Active and Unencumbered Compact Registered Nurse licensure required
- A minimum of three or more years experience in acute care, home health or case management experience.
- Medicare and/or Medicaid experience with geriatric populations a plus
- Certified Case Manager preferred
- Experience with community resource organizations
- Experience handling confidential health care information, with care management software applications
- Experience managing customers with complex medical and behavioral health concerns preferred
- Must have technical skills and ability to use multiple computer programs and systems, including Windows
- Must have access to reliable high-speed broadband internet with a modem/router
Knowledge, Skills, Abilities Required:
- Excellent interpersonal and communications skills
- Strong research and analytical skills
- Strong time management and organization skills
- Basic proficiency in Word, Outlook, PowerPoint, Excel
- Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
- Ability to make decisions on what needs to be done based on clearly established guidelines
- Spanish language ability is desirable
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.
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.
