Job Description Summary:

Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Provides clinical assessments, health education, and utilization management to members.

Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Manages own caseload and coordinates all assigned cases. Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. RN and current unrestricted nursing license required.

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

• Basic proficiency in Word, Outlook, PowerPoint, Excel

• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments

• Ability to make decisions on what needs to be done based on clearly established guidelines

• Spanish language ability is desirable

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.

For this position, we anticipate offering an annual salary of 68,700 - 114,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.