Nurse Case Manager Specialist
Location: Wilmington Delaware
Description: Cigna is currently interviewing Nurse Case Manager Specialist right now, this job will be placed in Delaware. For detail informations about this job opportunity kindly see the descriptions. Job Description
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- Manages/coordinates an active caseload of case management cases by providing Information, Navigation and Coordination to Customers outside the United States.
Uses clinical knowledge to assess the treatment plan and goals, and identifies gaps in care or risks for readmission or complications.
- Establishes patient centric goals and interventions to meet the member’s needs
- Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
- Balances business needs with patient advocacy
- Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers
- Based on experience, may provide leadership, preceptor/mentorship, support and coverage to other case management staff and assist case managers in achieving positive outcomes and savings
- Assists Utilization Review as needed/ requested .
- RN Licensure; case management certification preferred
- Experience in Utiliz! ation Management and Case Management
- Demonstrated str! ong organizational and leadership skills
- Strong interpersonal and communication skills
- Demonstrates problem-solving and analytical skills.
- Knowledge of utilization or case management, cost containment services, managed care, insurance coverage, and financial management
- Ability to act as an “advocate†for the customer while complying with internal Policies and procedures and contractual/legal compliance requirements
- Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
- Ability to build solid working relationships with staff, matrix partners, customers and providers
- Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.
- 24/7 support to Care Senior Associate Team as needed telephonically
- Establishes a collaborative relationship with client (plan participant/member), family, physic! ian(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
- Provide international customer base with “ assistance “ support including; “Information, Navigation and Coordination†through customer advocacy, provider identification, assistance with health care coordination and healthcare navigation though use of internal resources and global clinical team.
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
- Negotiates price, level of care, intensity! and duration with provider(s), as appropriate.
- Acts as a time! ly and proactive 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.
- Maintains accurate workflow and process documents
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
- Compliant with all accreditation, State and Federal mandates
- Delivers utilization review services when member is in active case management as appropriate
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Demonstrates sensitivity to culturally diverse situations, clients and customers. .
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If you were eligible to this job, please email us your resume! , with salary requirements and a resume to Cigna.
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This job starts available on: Mon, 09 Sep 2013 20:17:54 GMT