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Nurse Case Management Lead Analyst

3 months ago

Remote, Oregon, United States The Cigna Group Full time

Hours Required: 11:00 a.m.
--7:30 PM CST or 11.30 a.m.--8:00 PM CST

Position Scope:

The Digital/Telephonic RN Coach uses digital technology and telephonic interactions to inspire and support customers through behavior change on their unique health journey.
  • The coach is responsible for providing wellness coaching, medical decision support, information on potential gaps in care and risks for readmission or complications to customers through telephonic assessment, education, support, and referrals to various health and wellness programs.
  • Utilizes techniques such as motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
  • The RN Coach will support customers working in conjunction with an existing team of Health Advisors.
  • Manages/coordinates an active caseload of digital and telephonic coaching cases.
  • Establishes customer centric goals and interventions to meet the customer's needs.
  • Interfaces with the customer, family members/caregivers, the healthcare team, and internal matrix partners via digital and telephonic communication.
  • Balances business needs with patient advocacy.
  • Builds solid working relationships with internal team members, matrix partners, key functional areas, customers and providers.
  • Major responsibilities and desired results:
  • Provides 1:1 digital/telephonic coaching to customers around behavior change to improve health status, reduce health risks and improve quality of life.
  • Assesses readiness to change and implements actions to assist customers in reaching their goals.
  • Works with customers to identify and set personalized health improvement plans and goals, supporting them along the way.
  • Identifies customer health education needs through health assessment activities.
  • Uses health prevention guidelines and general health and wellness strategies to achieve goals in the overall health of customers.
  • Researches relevant topics in health promotion and disease prevention, as required for specific customers.
  • Collaborates with nutritionist, pharmacist, behavioral clinician, MD and customer's provider and other Cigna Medical Management Programs as appropriate.
  • Provides decision support where multiple treatment options are available.
  • Empowers customers with skills to provide enhanced interaction with their providers.
  • Complies with all accreditation, State and Federal mandates.
  • Completes training as required per role and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
  • Performs other related duties incidental to the work described herein.

Cultural Beliefs:

Additionally the candidate will be responsible for the adoption and demonstration of the Care Coordination cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.1. Customer Strong: I make a wow difference for our customers2. Me to We: I take accountability to trust, collaborate and partner3. Listen to Advocate: What matters to you, matters to me4. Be Bold: I know before I go and challenge the status quo5. Own It: I see a need and act because I can6. Think it Through: I proactively deliver solutions focused on doing the right thing

Minimum requirements:

  • Active unrestricted Registered Nurse (RN) license required
  • Two years full-time equivalent of direct clinical care to the consumer required
  • Good interpersonal and communication skills
  • Access to high-speed broadband wired internet with a modem/router. Cannot support satellite-based internet or hot spots

Preferred requirements:

  • A minimum of three (3) years of direct care clinical experience
  • Bilingual in English/Spanish a plus
  • RN with current licensure required
  • Diverse Clinical experience preferred
  • Bachelor's degree preferred
  • Experience with direct customer communication (written and oral)
  • Experience in digital/telephonic coaching preferred
  • Experience in health education and wellness coaching.
  • Competencies preferred:
  • Inspires and motivates customers to make positive behavior changes that fit their unique situations.
  • Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
  • Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.
  • Agility to toggle between and troubleshoot multiple systems and applications and troubleshoot technology issues.
  • Anticipates and adopts new technology and provides feedback to drive innovation.
  • Ability to partner with a team to build cohesion and drive outcomes for our programs and customers.
  • Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
  • Demonstrates sensitivity to culturally diverse situations, participants and customers.
  • Demonstrates effective organizational skills and flexibility to meet the business needs.
  • Strategic thinker who can come up with several solutions to solve a problem and will analyze them quickly to determine the best course of action.
  • Prioritizes work to meet commitments aligned with organizational goals.
  • Must be able to work independently and is able to exhibit creative thinking.
  • Overcomes roadblocks without being deterred by initial set-backs.
  • Adapts approach and demeanor in real time to match the shifting demands of different situations.
  • Ability to work within changing business environment and balance business needs with patient advocacy.
  • Manages multiple, complex situations in a fast paced environment collaborating with clinical and other business partners.
  • Strong skills in the following areas: teamwork, conflict management, ability to recommend changes and effective decision making.

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.For this position, we anticipate offering an annual salary of 75, ,500 USD / yearly, depending on relevant factors, including experience and geographic location.

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 Group.

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: for support. Do not email 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.