Cigna Work From Home Jobs – Nurse Case Manager

Job Description:

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.

Job Responsibilities:

• 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 timely 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.
• 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.

Job Requirements:

• Demonstrates sensitivity to culturally diverse situations, clients and customers.
• 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
• Engage our CAC partner (Embedded Care Coordinator) to support service to our customers.
• Participates in committees, task forces and other company projects as assigned and other assigned tasks as deemed necessary to meet business needs.

Job Details:

Company: Cigna

Vacancy Type:  Full Time

Job Location: Wilkes Barre, PA, US

Application Deadline: N/A

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