Cigna Medicare Population Health Nurse Case Management Senior Analyst
2 weeks ago
The job title for this role is Nurse Case Management Senior Analyst, and it falls under the Band 3 Senior Contributor Career Track.
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We highly esteem our skilled employees, and we always strive to support their professional growth before seeking external candidates for open positions. If you believe the position you are viewing is a good fit for you, we encourage you to submit your application.
Our team members are key to our success.
Job Summary:
Responsible for handling specific delegated tasks within the Case Management field, this role involves managing moderately complex cases. The duties include conducting reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. The Nurse Case Manager evaluates the effectiveness of care services, ensures quality care, and maintains a close relationship with counseling and treatment facilities.
This position involves evaluating employee counseling and treatment needs, making recommendations for program improvements, managing a caseload, and coordinating assigned cases. The role requires forward planning, issue anticipation, and resolving non-routine problems.
Job Description:
The Nurse Case Manager Senior Analyst promotes health outcome improvements for members through the case management process. Responsibilities include assessing, planning, implementing, coordinating, monitoring, and evaluating health options and services for individuals within a specific population. The Case Manager focuses on achieving quality, cost-effective outcomes by managing care needs throughout the continuum of care.
Key skills required include effective communication, consumerism approach, ability to work independently, and strong telephonic communication skills.
Responsibilities:
- Build collaborative relationships with clients, families, physicians, and providers to determine medical history, assess current status, and evaluate options for optimal outcomes.
- Obtain consent and create client-centric case management plans involving all relevant parties.
- Assess member's health status, identify barriers to healthcare, and implement, monitor, and evaluate case management plans.
- Adhere to professional practice standards, quality assurance, and case management policies.
- Participate in training, maintain clinical expertise, and show sensitivity to diverse situations.
Minimum Requirements:
- Active RN license in the U.S.
- Two years of direct clinical care experience.
- Previous case management experience preferred, focusing on specific populations and care coordination.
- Knowledge of community resources and excellent communication skills.
- Strong time management, organization, research, and problem-solving skills.
- Ability to work independently and in a fast-paced environment.
- Experience with senior populations and chronic conditions.
- Knowledge of managed care.
Preferred Requirements:
- CCM certification within three years of hire.
- Strong computer skills and experience with MS Word, Excel, Outlook.
- Skills in teamwork, conflict management, decision-making, and medical management.
- Experience in managed care settings and with Behavioral Health populations.
- Bilingual proficiency is a plus.
This position allows for remote work. Employees must be fully vaccinated if working onsite.
Expect a competitive annual salary and eligibility for an annual bonus plan. Enjoy comprehensive health benefits, 401(k) matching, life insurance, tuition reimbursement, paid time off, and more.
We foster a diverse and inclusive workplace and consider all qualified applicants without discrimination.
Applicants must meet our posting guidelines to be considered for this role. Please refer to our policy for more information.
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