Nurse Case Manager Sr. Analyst
- Full-Time
- Hartford, CT
- Cigna
- Posted 3 years ago – Accepting applications
Job Description
The Service Coordinator is responsible for providing service coordination and case/care management to STAR+PLUS and/or MMP Members. The Service Coordinator has an overarching philosophy of independent living, self-determination, and community integration.
ESSENTIAL FUNCTIONS
Works with member, member’s family, and providers to develop and implement a comprehensive individualized service plan.
Conducts a comprehensive in person and/or telephonic member assessment using state mandated assessment tools.
Conducts health risk and other member assessments.
Uses clinical judgment to identify physical and behavioral health needs and works with the member and caregiver to establish an appropriate plan of care and services that minimize needs based on medical necessity criteria and benefit guidance.
Works with member to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care.
Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions.
Completes and files all assessments and implements the care plans within the timelines outlined by the state.
Maintains a maximum weekly face to face visit schedule of seven members for field-based nurse coordinators, average caseload of 90.
QUALIFICATIONS
Required Qualifications:
Current contractor with Express Scripts or Cigna
Must be a Registered Nurse with a current, unrestricted Texas License
Strong organizational and time management skills
Must have strong computer skills using MS office products including Word, Excel, and Outlook
Excellent verbal and written communication skills
Must have reliable transportation, a valid and unrestricted driver’s license and proof of insurance.
The ability to travel to members’ homes, and other locations within the service delivery area.
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
Preferred Qualifications:
Previous STAR+PLUS experience.
Home Health Case Management experience with Medicare or Medicaid populations a plus
Experience managing members with chronic disease processes and
Experience working with community resource organizations preferred
Experience with care management software applications preferred.
This position is not eligible to be performed in Colorado.
About Cigna
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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.
Apply to this Job
ESSENTIAL FUNCTIONS
Works with member, member’s family, and providers to develop and implement a comprehensive individualized service plan.
Conducts a comprehensive in person and/or telephonic member assessment using state mandated assessment tools.
Conducts health risk and other member assessments.
Uses clinical judgment to identify physical and behavioral health needs and works with the member and caregiver to establish an appropriate plan of care and services that minimize needs based on medical necessity criteria and benefit guidance.
Works with member to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care.
Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions.
Completes and files all assessments and implements the care plans within the timelines outlined by the state.
Maintains a maximum weekly face to face visit schedule of seven members for field-based nurse coordinators, average caseload of 90.
QUALIFICATIONS
Required Qualifications:
Current contractor with Express Scripts or Cigna
Must be a Registered Nurse with a current, unrestricted Texas License
Strong organizational and time management skills
Must have strong computer skills using MS office products including Word, Excel, and Outlook
Excellent verbal and written communication skills
Must have reliable transportation, a valid and unrestricted driver’s license and proof of insurance.
The ability to travel to members’ homes, and other locations within the service delivery area.
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
Preferred Qualifications:
Previous STAR+PLUS experience.
Home Health Case Management experience with Medicare or Medicaid populations a plus
Experience managing members with chronic disease processes and
Experience working with community resource organizations preferred
Experience with care management software applications preferred.
This position is not eligible to be performed in Colorado.
About Cigna
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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.