LPN/LVN Case Management-Cigna Medicare - Population Health Short-Term - Work from Home, Florida
The Nurse will:
* Deliver professional activities in the Case Management job family.
* Coordinate enrollee care needs across the continuum for assigned members who are medically stable but require primary psychosocial support and acute intermittent medical support.
* Interview members and relatives to obtain social history relevant to medical problems and care planning.
* Assist members with environmental difficulties that interfere with obtaining maximum benefits from medical care.
* Serve as a liaison between primary care team, members, relatives and appropriate outside agencies.
* Apply standard techniques and procedures to routine instructions that require professional knowledge in specialist areas.
* Provide standard professional advice and creates initial reports/analyses for review.
* Provide guidance, coaching, and direction to more junior members of the team in Case Management
Responsibilities include:
* Responsible for the effective and sufficient support of all Case Management activities to include review of inpatient and outpatient medical records for appropriateness of case management resources.
* Uses an established set of criteria to evaluates and approve the necessity of case management services rendered.
* Provide notification of decisions in accordance with compliance guidelines.
* Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
* Works with management team to achieve operational objectives and financial goals.
* Supports teams across CM Department and throughout Clinical Operations as needed.
* Active participation and completion of all required trainings.
* Maintain Required Licensures.
* Adherence to regulatory and departmental timeframes for review of requests
* Meet/exceed department Turn Around time, daily established productivity goals, and management of medical cases
* Proficient knowledge of policies and procedures, Medicare, HIPAA and NCQA standards
* Professional demeanor and the ability to work effectively within a team or independently
* Flexible with the ability to shift priorities when required
* Other duties as required
Qualifications
* Current Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN.
* State Compact LPN License Required
* Minimum 3-5 years clinical experience.
* Managed Care and Case Management experience required
* Monday - Friday: 8:00 - 5:00 in candidates own time zone
* Clinical Care coordination for member, assist with getting appointments, transportation, medications, disease management, etc.
* Telephonic outreach - outbound & inbound calls
* Have a case load of 70-75 members
* Metrics - productivity minimum of 80 member outreaches/week
* Calls are recorded
* Help solve member needs within 45 days/open & close cases within 45 days
* Must like to be on the phone...
- Rate: Not Specified
- Location: Franklin, US-TN
- Type: Permanent
- Industry: Finance
- Recruiter: Cigna
- Contact: Recruiter Name
- Email: to view click here
- Reference: 24012598
- Posted: 2024-09-20 09:09:14 -
- View all Jobs from Cigna
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