![The Cigna Group](https://media.trabajo.org/img/noimg.jpg)
Nurse Case Management Manager
1 month 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.
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.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.
-
Nurse Case Manager RN
1 day ago
Phoenix, Arizona, United States Equiliem Full timeEquiliem is seeking a skilled nurse to fill a contract position in case management.Job DetailsSpecialty: Case ManagementDiscipline: Registered NurseEmployment Type: Local ContractPerks: Opportunity to work with a reputable healthcare organizationAs a Registered Nurse in Tuberculosis (TB) Services, you will play a vital role in diagnosis, treatment, and case...
-
Nurse Case Manager RN
2 days ago
Phoenix, Arizona, United States Equiliem Full timeEquiliem is seeking a skilled nurse to fill a contract position in case management.Job DetailsSpecialty: Case ManagementDiscipline: Registered NurseEmployment Type: Local ContractPerks: Opportunity to work with a reputable healthcare organizationAs a Registered Nurse in Tuberculosis (TB) Services, you will play a vital role in diagnosis, treatment, and case...
-
Licensed Practical Nurse
1 month ago
Phoenix, Arizona, United States Professional Case Management Full timeMake a Difference on Your Own Schedule and TermsProfessional Case Management, the leader in home healthcare, is now hiring LPN's/LVN's to provide in-home healthcare services to help those who have served our countryBenefit from one-on-one patient relationships and from the satisfaction of enhancing clients' health, quality of life and peace of mind.You make...
-
Nurse Case Manager Specialist
1 month ago
Phoenix, Arizona, United States The Cigna Group Full timeSummaryThe Nurse Case Management Lead Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG) primary care team. This role is aligned to and supports ENCG Healthcare Centers and clinicians to improve the health of the patients we serve, with a focus on the management of high- and rising-risk, disease burdened...
-
Mobile Case Management Nurse
1 day ago
Phoenix, Arizona, United States ACES Healthcare Staffing Full timeJoin ACES Healthcare Staffing as a: Registered Nurse - Case ManagementPosition Overview:We are seeking a dedicated and skilled Registered Nurse specializing in Case Management to provide exceptional care and support in various healthcare settings.Key Details:Estimated Weekly Compensation: $2680 - $2960Contract Duration: 13 weeksWork Schedule: 5x8 DaysWeekly...
-
Registered Nurse Case Management Specialist
24 hours ago
Phoenix, Arizona, United States Questpro Full timeJob OverviewWe are collaborating with a rapidly expanding, dedicated case management organization seeking a qualified RN Field Case Manager to contribute positively to the care of injured workers in the greater Chicago area. This role is ideal for nursing professionals who are eager to enhance their impact on patient care while minimizing administrative...
-
Field Nurse Case Manager
6 days ago
Phoenix, Arizona, United States Questpro Full timePosition OverviewWe are currently collaborating with one of the most rapidly expanding and dedicated case management firms in the sector, seeking an experienced RN Field Case Manager to contribute positively to the Greater Phoenix, AZ area. This role is ideal for professionals who prefer to focus on impactful case management rather than administrative tasks....
-
Field Nurse Case Manager
6 days ago
Phoenix, Arizona, United States Questpro Full timePosition OverviewQuestpro is seeking a dedicated and experienced RN Field Case Manager to support a growing network in the Greater Phoenix area. This role is pivotal in enhancing the quality of care for injured workers while ensuring effective cost management.Key ResponsibilitiesLeverage clinical expertise to coordinate treatment plans for injured workers,...
-
Field RN Case Manager
6 days ago
Phoenix, Arizona, United States Questpro Full timePosition OverviewWe are collaborating with a rapidly expanding, dedicated case management organization seeking an experienced RN Field Case Manager to contribute positively in the Greater Phoenix area. This role is ideal for those who wish to enhance their professional journey, focus on impactful case management rather than administrative tasks, or seek a...
-
Registered Nurse Case Manager
6 days ago
Phoenix, Arizona, United States Quality Home Health Care Full timeQuality Home Health Care, a leading provider of in-home healthcare services in Arizona, is seeking a dedicated and compassionate Registered Nurse (RN) to join our team. As an RN Case Manager, you will play a vital role in coordinating and delivering high-quality care to patients in their homes. You will work closely with patients, families, physicians, and...
-
Local RN Case Manager Position
7 days ago
Phoenix, Arizona, United States Equiliem Full timePosition OverviewEquiliem is currently seeking a dedicated local contract Registered Nurse specializing in Case Management. This role is essential for providing comprehensive care and support to individuals diagnosed with tuberculosis.Key ResponsibilitiesSpecialty: Case ManagementDiscipline: Registered NurseEmployment Type: Local ContractWork Schedule: 40...
-
Traveling RN Case Manager
1 day ago
Phoenix, Arizona, United States ACES Healthcare Staffing Full timeJoin ACES Healthcare Staffing as a: Registered Nurse - Case ManagementPosition Overview:We are seeking a dedicated Registered Nurse specializing in Case Management to embark on an exciting travel assignment. This role is designed for professionals looking to enhance their career while exploring new locations.Key Responsibilities:Provide comprehensive case...
-
Local RN Case Manager Position
6 days ago
Phoenix, Arizona, United States Equiliem Full timeEquiliem is seeking a dedicated Registered Nurse specializing in Case Management for a local contract role.Position OverviewThis position focuses on providing essential care and support for individuals diagnosed with tuberculosis, both latent and active. As a key member of the healthcare team, you will be responsible for:Diagnosis and Treatment: Engaging in...
-
Senior Case Management Specialist
1 day ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: Join a dedicated team at the Arizona Department of Economic Security (DES) that is committed to enhancing the lives of individuals and families. The Division of Developmental Disabilities (DDD) is on the lookout for a skilled and enthusiastic professional to fill the role of Senior Case Management Specialist. Our mission is to provide...
-
Case Management Support Specialist
7 days ago
Phoenix, Arizona, United States Phoenix Settlement Administrators Full timeJob OverviewPosition SummaryThe Case Management Support Specialist plays a crucial role in assisting the case management team at Phoenix Settlement Administrators. This position requires a strong ability to manage multiple tasks efficiently while providing exceptional service to our clients.Key QualificationsProficient in Advanced MS Office...
-
Newborn Screening Case Manager
1 day ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: This role is pivotal in delivering essential and timely follow-up and case management services for newborns and infants who exhibit abnormal screening results. The objective is to guarantee that infants with hearing impairments receive prompt identification, diagnosis, and treatment. Responsibilities include the evaluation of laboratory...
-
Newborn Screening Case Manager
6 days ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: This role is essential for executing critical follow-up and case management services for newborns and infants who have received abnormal screening test outcomes. The primary goal is to ensure early identification, diagnosis, and treatment for newborns with hearing impairments. Responsibilities include evaluating laboratory test results,...
-
Newborn Screening Case Manager
6 days ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: This role is dedicated to executing essential and timely follow-up and case management services for newborns and infants identified with abnormal screening results. The primary objective is to guarantee that infants with hearing impairments receive prompt identification, diagnosis, and treatment. Responsibilities include evaluating...
-
RN Care Manager
21 hours ago
Phoenix, Arizona, United States Centric Care Management Inc Full timeJob DescriptionCentric Care Management Inc is seeking a skilled RN Chronic Care Manager to join our team. As a Chronic Care Manager, you will play a vital role in providing high-quality patient care and ensuring positive outcomes for individuals with chronic conditions.Key Responsibilities:Conduct comprehensive assessments of patients with chronic conditions...
-
Child Support Services Case Manager
7 days ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timePosition Overview: Join a dedicated team at the Arizona Department of Economic Security (DES) that is committed to enhancing the lives of individuals and families across the state. The Division of Child Support Services (DCSS) is on the lookout for a skilled and enthusiastic Child Support Services Case Manager (CSS Officer 2) to contribute to our mission of...