Nurse Case Manager Senior Analyst

18 hours ago

Bloomfield, Connecticut, United States The Cigna Group Full time
About the Role

This position, the Nurse Case Manager Senior Analyst, plays a critical role in promoting the improvement of health outcomes for members and assisting those experiencing the burdens of illness and injury.

Key Responsibilities
  • Assess, plan, implement, coordinate, monitor, and evaluate options and services to meet an individual's health needs within case load assignments of a defined population based on business perspectives.
  • Promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
  • Establish a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
  • Obtain informed verbal consent and take all steps to obtain written consent as appropriate.
  • Promote consumerism through education and health advocacy.
  • Assess member's health status and treatment plan and identifies any gaps or barriers to healthcare.
  • Establish a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
  • Implement, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
  • Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
Requirements
  • Active unrestricted Registered Nurse (RN) license in state or territory of the United States
  • Two years full-time equivalent of direct clinical care to the consumer
  • Prior experience in case management, preferably with the Medicare/Medicaid population, focusing on Special Needs Plan, Model of Care documentation requirements, care coordination working with hospital settings and Primary Care Physician offices.
  • Knowledge of community resources is also helpful.
  • Excellent verbal and written communication and interpersonal skills
  • Ability to learn new processes and systems quickly
  • Strong time management and organization skills
  • Ability to prioritize the work
  • Strong research and analytical and problem-solving skills
  • Ability to work independently
  • Knowledge of managed care preferred
  • Effective coaching/education skills
  • Ability to work in rapidly changing environment
  • Experience with senior population and chronic conditions
  • Ability to work with people with significant educational and or socioeconomic barriers impacting their health
Preferred Requirements
  • Within three (3) years of hire as a case manager, the case manager will become CCM certified
  • Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
  • Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
  • Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
  • Experience in medical management and case management in a managed care setting is highly desirable
  • Knowledge of managed care products and strategies
  • Demonstrated sensitivity to culturally diverse situations, participants and customers
Benefits

This role is eligible to participate in an annual bonus plan. We offer a comprehensive range of benefits, with a focus on supporting your whole health, 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.

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