Nurse Case Manager (FT Queue) - Evernorth Health Services -Remote

Cigna Healthcare

1d•$77,500 - $129,100•Remote

About The Position

This is a full-time, remote Telephonic/Digital RN Case Manager role supporting members through inbound outreach and care coordination. A private, secure workspace in the home is required to protect confidential information. The schedule is in Eastern Time and can be 9:30 a.m.–6:00 p.m. ET, 10:00 a.m.–6:30 p.m. ET, or 10:30 a.m.–7:00 p.m. ET. The role involves managing a high volume of inbound calls, completing call documentation and after-call work within required timeframes, and working effectively in a fast-paced environment. It requires applying critical thinking, demonstrating proficiency with required systems and tools, and meeting established quality and productivity expectations. The position is responsible for identifying and addressing immediate customer concerns, researching and providing solutions, assessing customers for ongoing complex case management needs, and assigning to a client-based CM for further management when appropriate. It also requires skilled utilization of Cigna resources and promoting quality, cost-effective alternatives to acute care.

Requirements

Active, unrestricted Registered Nurse (RN) license in state of residence.
Minimum of two years of direct patient-care experience as an RN
One year of experience as a Cigna Complex or Specialty Case Manager, meeting role expectations and performance metrics.
Excellent time management, organizational, research, analytical, negotiation, communication (verbal and written) and interpersonal skills.
Proficient with computers and case management systems; able to communicate with customers while documenting in real time.
Must meet Cigna internet and work-at-home requirements
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Responsibilities

Obtains informed consent per policy, including verbal consent and required written authorization.
Acts with speed and purpose to identify, support and resolve customer healthcare needs.
Establishes a collaborative relationship with the Customer, client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care.
Sets a plan for short term and long-term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure.
Implements, coordinates, monitors and evaluates the case management plan on an ongoing basis in collaboration with the client and treating providers as appropriate.
Documents findings in a clear concise manner and continues to evaluate medical necessity of frequency, intensity and length of care with physician(s) and agency/vendor(s) on an ongoing basis.
Acts as liaison between account, client/family, physician(s) and facilities/agencies.
Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.
Adheres to quality assurance standards and all case management policy and procedures.
Acts as a preceptor for Case Managers for training and/or performance issue, as able and as assigned.
Demonstrates sensitivity to culturally diverse situations and member needs; performs other duties as assigned to meet business needs.
Ensures the member’s privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards.
Responsible for receiving all inbound telephonic calls from Personal Advocate, auto-dialer and other internal call transfers.
Manages a high volume of inbound calls; maintains scheduled availability; completes call documentation and after-call work within required timeframes.
Works effectively in a fast-paced environment; applies critical thinking; demonstrates proficiency with required systems and tools.
Meets established quality and productivity expectations, including engagement goals, in alignment with program requirements.
Responsible for identifying and addressing any immediate customer concerns, researching and providing solutions, when possible, along with assessing customer for ongoing complex case management needs and assigning to a client-based CM for further management when appropriate.
Must be skilled in utilization of Cigna resources when identifying need for further customer support.
Be organized, knowledgeable and thorough while promoting quality case effective outcomes, and provides quality, cost effective alternatives to acute care.