Nurse Case Manager Analyst

The Cigna Group; Salamanca; Presencial; EUR 40.000 - 60.000; Jornada completa

Descripción de la vacante

A leading healthcare company is seeking a Clinical Case Manager to enhance healthcare outcomes for members outside the US. The role involves managing case loads, assessing treatment needs, and collaborating with healthcare teams. Candidates must possess Nurse Licensure and be fluent in English and Japanese, showcasing strong organizational and interpersonal skills.

Formación

• Fluent in English and Native Japanese speaker with reading/writing skills in Katakana, Kanji, and Hiragana.
• Strong organizational and leadership skills.
• Problem-solving and analytical skills are essential.

Responsabilidades

• Manages an active caseload of case management cases and coordinates care for customers outside the US.
• Uses clinical knowledge to assess and establish customer-centric treatment plans.
• Evaluates medical information against criteria and determines medical necessity.

Conocimientos

Organization

Leadership

Interpersonal Communication

Problem Solving

Analytical Skills

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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