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RN Care Coordinator

2 months ago


Maitland, Florida, United States The Cigna Group Full time
About the Role

We are seeking a highly skilled RN Care Coordinator to join our team at Evernorth Direct Health. As a key member of our care coordination team, you will play a critical role in ensuring the delivery of high-quality, patient-centered care to our members.

Key Responsibilities
  • Identify and refer appropriate customers to eligible programs within CIGNA Healthcare (CHC) and all eligible client-specific health and wellness programs.
  • Support care coordination of the individual customer, coordinating the care of the high-risk targeted population in an appropriate, efficient, high-quality, and cost-effective manner.
  • Partner with and function as a central conduit between employer, provider (PCP, Onsite Health Clinic), and all available Evernorth programs and resources.
  • Support established process and procedures that ensure thorough review of patient-level actionable data and reports used to support identification of customers for outreach and engagement.
  • Assure and maintain timely, compliant, efficient documentation and information exchange to drive appropriate outreach, engagement, and positive clinical outcomes with aligned population.
  • Communicate clearly with all matrix partners and refer to appropriate internal and external programs to support outcomes.
  • Identify cases appropriate for complex case management and follow process for referral.
  • Work effectively with Evernorth's internal team to support coordination of care and data analysis.
  • Identify and build effective relationships with local network providers, providing steerage to high-quality network providers and referrals to the onsite health center.
  • Identify gaps in care and work with providers and/or local community resources to close gaps in care.
  • Establish and maintain a positive, professional, and collaborative relationship with customer/employee, employer, providers of care, and Evernorth partners to support improved outcomes (clinical, quality, and cost) of aligned employee population.
  • Partner and coordinate with health management matrix partners for additional engagement and promotion opportunities.
  • Act as a resource to direct customers with specific non-clinical questions to the appropriate resource.
Requirements
  • RN with current unrestricted state licensure within home state.
  • Must have three or more years of clinical practice experience.
  • Case Management experience is preferred.
  • A high energy level with excellent oral and written communication skills.
  • Excellent computer skills, including specific software (e.g., Word and Excel).
  • Excellent interpersonal skills, with the ability to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly.
  • Demonstrate commitment to ongoing education preferred.
  • Comfortable communicating with multiple clinical partners (direct care, Onsite Health, and telephonic coaching and case management teams).
  • Experience working with high-risk patients preferred.
  • Experience in project development and working in a matrix environment preferred.
  • Self-directness and the ability to succeed in an independent role.
  • Current BLS/CPR/AED certification.
  • Passion for assisting members with health improvement and navigation of the healthcare system.
  • Must have strong problem-solving skills.
Preferred Qualifications
  • CHES
  • Health Coaching experience, including chronic disease management
  • High energy level, with dynamic presentation skills required.
  • Positive role model in demonstrating healthy behaviors.