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...