Nurse Case Manager Senior Analyst
Nurse Case Manager Senior Analyst
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Job Description
LOOKING FOR A NEW CHALLENCE IN AN INTERNATIONAL ENVIRONMENT
YOUR MISSION:
The Nurse Case Manager will assess plan implement coordinate monitor and evaluate options and services to meet an individuals health needs. Assistance may include such activities as providing clinical information regarding medical conditions or treatments identifying providers and coordinating complex care plans . The Nurse Case Manager will promote quality cost-effective outcomes managing care needs through education and health advocacy to members serviced. The Nurse Case manager is able to work independently and effectively communicate to internal and external customers by telephone email or face to face with customers.
KEY AREAS:
Uses clinical knowledge to assess diagnosis and treatment plans and goals and identifies gaps in care or risks for readmission or complications.
- Manages/coordinates an active volume of cases by providing information and coordination to customers worldwide in a multicultural population.
- Establishes patient centric goals and interventions to meet the members needs.
- Interfaces with the member family members/caregivers and the healthcare team as well as internal matrix partners.
- Balances business needs with patient advocacy.
- Assesses members health status and treatment plan and identifies any gaps or barriers to healthcare.
- Coordinate care for customers by reviewing medical and claim information ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
- Establishes 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.
- Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
- Responsible for delivering to customers clinical programs including case management chronic condition management lifestyle coaching pre assignment assessment and any other program delivered by global clinical operations.
- Coordinate care with other nurses around the world when a need for local or regional expertise is important for better care or to comply with regulations.
- Maintains accurate workflow and process documents.
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Serve as clinical liaison to Clients.
SKILLS AND KNOWLEDGE:
- Bachelor in Nursing 3-5 years of experience in international clinical management.
- Languages required: English Spanish and a third European language (French Dutch Italian or German)
- Demonstrated organizational and leadership skills.
- Strong interpersonal and communication skills.
- Demonstrates problem-solving and analytical skills.
- Ability to act as an advocate for the customer while complying with internal policies and procedures and contractual/legal compliance requirements.
- Ability to operate personal computer proficient with Microsoft office products call center software and a variety of software.
- Ability to build solid working relationships with staff matrix partners customers and providers.
About Cigna Healthcare
Cigna Healthcare a division of The Cigna Group is an advocate for better health through every stage of life. We guide our customers through the health care system empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.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.
If you require reasonable accommodation in completing the online application process please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
Required Experience:
Manager
Employment Type
Full-Time
