Field Registered Nurse - Evernorth - Philadelphia, PA

Cigna - Philadelphia, PA

Full-time - Mid Level

Hybrid - Philadelphia, PA

Insurance Carriers and Related Activities

About the position

The Field RN position in the At Home Care program is a vital role that focuses on providing comprehensive nursing care to patients in their homes. This position requires the RN to conduct in-home visits, perform nursing assessments, triage patients, coordinate care, and educate both patients and their families about health management. The RN will primarily work with patients enrolled in the Chronic Risk Program and the Advanced Care Program, ensuring that they receive the necessary support and guidance to manage their health effectively. In this role, the RN will assess patients' health care needs, prioritize their urgency, and utilize creative problem-solving skills to recommend appropriate care plans. Documentation of nursing assessments, interventions, and patient responses will be crucial, as it must be timely and compliant with policy standards. The RN will also be responsible for making follow-up calls to patients, providing telephonic assessments, and initiating medication changes as directed by the provider. The RN will play a key role in improving health literacy among patients, coaching them on chronic conditions, medication management, and individualized care goals. They will identify gaps in care and coordinate services and referrals to health programs, participating in patient education initiatives tied to HEDIS metrics. Additionally, the RN will support providers by completing assessments related to social determinants of health and assisting in organizing interdisciplinary care team rounds. Collaboration with health plan case management will be essential, as the RN will participate in weekly care coordination meetings and manage referrals, including hospice consults. This position requires a proactive approach to patient care and a commitment to improving access to healthcare services while managing costs and utilization effectively.

Responsibilities

• Conduct in-home visits for nursing assessments and patient triage.
• Provide health care advice and education regarding health promotion and disease management.
• Systematically assess patients' health care needs and prioritize urgency.
• Document nursing assessments and interventions in the electronic health record.
• Make follow-up calls to patients and referrals as appropriate.
• Provide telephonic nursing assessment and triage supported by protocols.
• Initiate medication changes as directed by the provider.
• Improve health literacy and coach patients on chronic conditions and medication education.
• Identify problems or gaps in care and offer interventions.
• Coordinate services and referrals to health programs and participate in patient education initiatives.
• Complete telephonic nursing assessments including social determinants of health screenings.
• Assist in organizing chronic care and interdisciplinary care team rounds.
• Participate in creating care plans for patients using a team approach.
• Maintain and update documentation for weekly rounds.
• Participate in weekly care coordination with health plan case management.
• Manage referral tracking for hospice consults.

Requirements

• Active, unrestricted RN license in Pennsylvania.
• Ability to obtain compact license and/or additional state licensure as needed.
• 3 or more years of experience as a Registered Nurse.
• Proficient in Microsoft Office applications and strong technical aptitude.
• Experience and proficiency with EMR systems.
• BSN or ADN degree.

Nice-to-haves

• Previous experience working with the geriatric population or chronic conditions.
• Home health experience.
• Triage experience.
• Case management experience.
• Previous customer service experience.
• Experience in a telephonic role.
• Highly organized and self-directed with the ability to function in a high-volume environment.
• Strong verbal and written communication skills.
• Prior clinical experience in palliative care, hospice, oncology, ICU, or geriatrics is preferred.
• Knowledge of STARS and HEDIS metrics is a plus.

Benefits

• Sign-on bonus available.
• Health insurance coverage.
• Flexible scheduling options for work-life balance.
• Professional development opportunities.
• Support for ongoing education and skill development.