RN Care Coordinator

2 days ago

Philadelphia, Pennsylvania, United States Cigna Full time
About the Role

Cigna is seeking a highly skilled RN Care Coordinator to join our team. As a RN Care Coordinator, you will play a critical role in coordinating and streamlining services for our patients, ensuring they receive the best possible care.

Key Responsibilities
  • Act as the primary point of contact for patients, coordinating all aspects of their care, including appointments, schedules, and orders.
  • Serve as a liaison between providers and patients, directing and delegating tasks to team members as needed.
  • Provide patient education and coaching on chronic conditions, disease process, and medication management.
  • Review paperwork and ensure it meets all requirements, explaining test results and diagnoses to patients.
  • Cover triage and transition of care for patients, including telephonic post-discharge hospital visits and medication reconciliation.
Health Literacy Improvement
  • Improve health literacy and coach patients on chronic conditions, including disease process and trajectory, medication education, and individualized care goals management.
  • Identify problems or gaps in care and offer opportunities for intervention.
  • Coordinate services and referrals to health programs and participate in patient education and outreach tied to HEDIS initiatives.
  • Work to improve access to care and manage healthcare costs and utilization.
Provider Support
  • Complete telephonic nursing assessments, including social determinants of health screenings, post-hospital discharge screenings, triage, and other assessments assigned by providers.
  • Assist with organizing and running chronic care and/or interdisciplinary care team rounds, identifying high-risk patients and care plans.
  • Participate in a team approach to create care plans for patients.
  • Maintain and update spreadsheets and documents provided by health plans to prepare weekly rounds of documentation.
Post-Acute Management and Coordination
  • Participate in weekly care coordination with health plan case management as directed by market needs.
  • Referral management care coordination and tracking of hospice consults within 24 hours of order placement.
Diagnostics and Lab Result Management
  • Obtain pre-authorization for all CT, MRI, Echo's ordered by providers, scheduling as needed.
  • Serve as a guide in their POD for all escalated orders and results, providing clinically appropriate support.
Additional Responsibilities
  • Nursing triage: assess and triage immediate health concerns transferred to nursing team by clinical support staff.
  • Provide telephonic nursing assessment and triage, supported by triage protocols, including timely and accurate triage documentation, escalation, and follow-up.
  • Initiate medication changes and other orders, as directed by providers in response to a triage call.
Transition of Care
  • Monitor daily discharge list and develop a plan to schedule transition of care visits within the allotted timeframe.
  • Complete telephonic post-discharge hospital visits, asking pertinent discharge triage questions and completing medication reconciliation.
  • Document all findings and make appropriate referrals to social work, pharmacy, case management, and engagement.
Competencies
  • Communicates Effectively: developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
  • Manages Ambiguity: operating effectively, even when things are not certain or the way forward is not clear.
  • Courage: stepping up to address difficult issues, saying what needs to be said.
  • Manages Complexity: making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
  • Demonstrates Self-Awareness: using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.
  • Situational Adaptability: adapting approach and demeanor in real time to match the shift in demands of different situations.
  • Collaborates: building partnerships and working collaboratively with others to meet shared objectives.
Minimum Qualifications
  • Active, unrestricted RN license in all states we provide services.
  • Ability to obtain compact license and/or additional state licensure as needed.
  • 3+ years of experience as a Registered Nurse.
  • Proficient level of experience with Microsoft Office applications and strong technical aptitude.
  • EMR experience and proficiency.
  • BSN or ADN degree.
Preferred Qualifications
  • Previous experience working with the geriatric population/chronic condition experience.
  • Home Health experience.
  • Triage experience.
  • Case management experience.
  • Previous customer service experience.
  • Previous experience in a telephonic role.
  • Highly organized, self-directed worker with an ability to function in a high-volume environment.
  • Strong verbal and written communication skills.
  • Prior clinical experience in palliative care, end-of-life, hospice, oncology, ICU, geriatrics is preferred.
  • Knowledge of STARS and Hedis metrics a plus.

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