Nurse Case Manager Analyst

The Cigna Group; Jaén; Presencial; EUR 30.000 - 50.000; Jornada completa

Descripción de la vacante

A leading healthcare advocate, The Cigna Group seeks a Clinical Case Manager to improve health outcomes for members. The role involves assessing and coordinating care for members, ensuring quality service delivery across diverse populations. Applicants must be licensed nurses fluent in English and Japanese, committed to providing patient-centered advocacy and care management.

Formación

• Fluent in English and native Japanese speaker, proficient in Katakana, Kanji, and Hiragana.
• Demonstrated strong organizational and leadership skills.
• Ability to advocate for customers while complying with policies.

Responsabilidades

• Manage and coordinate an active caseload of case management cases.
• Develop customer-centric treatment plans and identify care gaps.
• Maintain accurate records of case management interventions.

Conocimientos

Organizational skills

Leadership skills

Communication skills

Problem-solving skills

Analytical skills

Cultural sensitivity

Educación

Nurse Licensure

Descripción del empleo

This position through the case management process will promote the improvement of clinical outcomes to members and assist those members experiencing illness and injury. The Clinical Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population based on business perspectives. The Clinical Case Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills through education and health advocacy to members serviced. Ability to work independently and effectively communicate to internal and external customers using different channels (videoconferencing and international phone calls).

Position Scope :

• Manages / coordinates an active caseload of case management cases by providing Information, Navigation and Coordination to Customers outside the United States.

Major responsibilities and desired results :

• Uses clinical knowledge to assess and establish customer centric treatment plans, goals and identifies gaps in care or risks for readmission or complications.
• Interfaces with the member, family members / caregivers, and the healthcare team / provider, as well as internal matrix partners.
• Maintains accurate record (system) of case management interventions including cost / benefit analysis, savings, and data collection.
• Evaluates medical information against criteria, benefit plan, coverage policies and determines medical necessity.
• Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers
• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures

Minimum requirements :

• Nurse Licensure.
• Language skills : Fluent reading, writing and speaking in English. Required to be a Native Japanese speaker and can read, write and speak fluently in Katakana, Kanji and Hiragana; any additional language is a plus.
• Demonstrated strong organizational and leadership skills.
• Strong interpersonal and communication skills.
• Demonstrates problem-solving and analytical skills.
• Ability to act as an “advocate” for the customer while complying with internal Policies and procedures and contractual / legal compliance requirements.
• Demonstrates sensitivity to culturally diverse situations, clients and customers.

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 : for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

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