Cigna Medicare Population Health Nurse Case Manager

Position Summary:

Plans, implements, and evaluates appropriate health care services to assist the customer throughout the continuum of care.

Utilizes clinical skills to assess, coordinate, monitor and evaluate options and services in order to facilitate appropriate health care outcomes for customers.

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

Maintains current knowledge of Cigna Healthcare Policies and Procedures, CMS requirements, State Medicaid requirements, NCQA standards and recommendations impacting care coordination, and Special Needs Plans Model of Care program goals and requirements, as applicable.

Essential Duties and Responsibilities:

• Outreach to customers for coordination of care and continuity of care management.

• Identify customer needs, coordinate and support planned and unplanned transitions, conduct post discharge follow up contact, which may include primary care physician and specialist appointment scheduling.

• Provide clinical assessments, health education, and utilization management to customers, as needed.

• Initiate contact with customer/caregiver/family, primary care physician, and health care providers/suppliers as needed.

Conduct health risk assessments, which may include on-site evaluations (customer home visits) as needed.

• Develop and monitor customer's individualized plan of care, as well as communicate the plan of care to the customer and primary care physician.

Prioritize case goals, monitor the completion of care goals and modify the individualized plan of care in the integrated care management system as needed.

• Document all encounters with the customer and practitioners and providers.

• Resolve any immediate issues for customers after screening but prior to routing for Case Management.

• Evaluate each case for quality of care, document and report quality issues to the appropriate team.

• Other duties as assigned.

Qualifications :

• Active and Unencumbered Compact Registered Nurse licensure required

• A minimum of three or more years experience in acute care, home health or case management experience.

• Medicare and/or Medicaid experience with geriatric populations a plus

• Certified Case Manager preferred

• Experience with community resource organizations

• Experience handling confidential health care information, with care management software applications

• Experience managing customers with complex medical and behavioral health concerns preferred

• Must have technical skills and ability to use multiple computer programs and systems, including Windows

• Must have access to reliable high-speed broadband internet with a modem/router

Knowledge, Skills, Abilities Required :

• Excellent interpersonal and communications skills

• Strong research and analytical skills

• Strong time management and organization skills

• ...