(RN) Nurse Case Manager - Evernorth Health Services -Remote

The Cigna Group • North Fayette Township, PA

16h • Remote

About The Position

The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.
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Position Scope
Hours for the Position: Must be able to work an 8-hour-shift between the business hours of 9a-9p EST. Flexibility is required to meet business needs. Must be open to work evenings.
Nurse Case managers are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers, families, and caregivers to assist with navigating through the healthcare journey.
Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.
Customer Strong: I deliver world-class experiences for all my customers.
Me to We: I take accountability to trust, partner, and deliver.
Own It: I see a need and deliver value because I care.
Evolve and Adapt: I learn and adapt to meet evolving business needs.
Be Bold: I pioneer and think broadly to solve challenges.
Take Care: I prioritize self-care and act with compassion toward colleague.

Requirements

• Active unrestricted Registered Nurse (RN) license in state or territory of the United States
• Two years of full-time direct patient care setting as an RN required.
• Must be flexible to work days or evenings based on business needs
• Requires a nursing degree from an accredited nursing program
• Must have an active and unencumbered RN License in the State of Residence
• Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
• Skilled in clinical acumen to form a judgement and act.
• Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.
• Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
• Demonstrates sensitivity to culturally diverse situations, participants, and customers.
• Demonstrates effective organizational skills and flexibility to meet the business needs.
• Adapts approach and demeanor in real time to match the shifting demands of different situations.
• Ability to manage multiple, complex situations in a fast-paced environment collaborating with clinical and other business partners.
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Nice To Haves

• Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.
• Some roles may require on-site meetings or audits twice a year required

Responsibilities

• Collaborates with customer in creation of care plan and documents plan in medical management system.
• Partners with each customer to establish goals and interventions to meet the customer’s needs.
• Establishes plan of care in conjunction with the customer and provider then document into a medical management system.
• Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
• Empowers customers with skills to enhance interaction with their providers.
• Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
• Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer's provider and other Cigna Medical Management programs to provide whole-person health support.
• Tracks daily activities to trend volume and outcomes.
• Follows standard operating procedures.
• Toggles between multiple systems and applications.
• Research relevant topics in health promotion and disease prevention, as required for specific customers.
• Prioritizes work to meet commitments aligned with organizational goals.
• Understands and adheres to Case Management performance measures to deliver on key results.
• Completes training within the communicated time limit as required per role.
• Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

Benefits

• At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree