Cigna Medicare Population Health Nurse Case Manager

About the position

The Cigna Medicare Population Health Nurse Case Manager is responsible for planning, implementing, and evaluating healthcare services to assist customers throughout their care continuum. This role involves utilizing clinical skills to assess, coordinate, monitor, and evaluate options and services to facilitate appropriate healthcare outcomes. The position ensures that case management program objectives are met by evaluating the effectiveness of alternative care services while maintaining cost-effective, quality care. The nurse will also stay updated on relevant healthcare policies and standards impacting care coordination.

Responsibilities
• Outreach to customers for coordination of care and continuity of care management.
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• 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.
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• Provide clinical assessments, health education, and utilization management to customers, as needed.
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• Initiate contact with customer/caregiver/family, primary care physician, and healthcare providers/suppliers as needed. Conduct health risk assessments, which may include on-site evaluations (customer home visits) as needed.
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• Develop and monitor customer's individualized plan of care, as well as communicate the plan of care to the customer and primary care physician.
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• Prioritize case goals, monitor the completion of care goals and modify the individualized plan of care in the integrated care management system as needed.
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• Document all encounters with the customer and practitioners and providers.
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• Resolve any immediate issues for customers after screening but prior to routing for Case Management.
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• Evaluate each case for quality of care, document and report quality issues to the appropriate team.
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• Other duties as assigned.

Requirements
• Active and Unencumbered Compact Registered Nurse licensure required.
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• A minimum of three or more years experience in acute care, home health or case management experience.
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• Medicare and/or Medicaid experience with geriatric populations a plus.
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• Certified Case Manager preferred.
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• Experience with community resource organizations.
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• Experience handling confidential health care information, with care management software applications.
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• Experience managing customers with complex medical and behavioral health concerns preferred.
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• Must have technical skills and ability to use multiple computer programs and systems, including Windows.
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• Must have access to reliable high-speed broadband internet with a modem/router.

Nice-to-haves
• Spanish language ability is desirable.

Benefits
• Medical, vision, and dental insurance coverage starting on day one.
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• Well-being and behavioral health programs.
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• 401(k) with company match.
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• Company paid life insurance.
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• Tuition reimbursement.
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• A minimum of 18 days of paid time off per year and paid holidays.

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