RN Nurse Case Management Senior Analyst - Medicare - Work from Home, Arizona (Compact RN License Req

* Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family.

Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.

Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.

Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.

Provides clinical assessments, health education, and utilization management to members.

Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.

Manages own caseload and coordinates all assigned cases.

Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.

Tasks involve a degree of forward planning and anticipation of needs/issues.

Resolves non-routine issues escalated from more junior team members.

RN and current unrestricted nursing license required.


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* Job Description


* This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury.

The Case Manager will 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.

The Case Manager will 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.

Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.

Position Scope:


* Manages/coordinates an active caseload of case management cases for Cigna Medicare.

Uses clinical knowledge to assess the treatment plan and goals and identifies gaps in care or risks for readmission or complications.


* Establishes patient centric goals and interventions to meet the member's needs.


* Interfaces with the member, family members/caregivers, and the healthcare team, and embedded care coordinator as well as internal matrix partners.


* Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers.


* Major responsibilities and desired results:

Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.


* Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and cu...