Nurse Case Manager Analyst

Cigna Health and Life Insurance Company; Hinoba-an; On-site; PHP 600,000 - 800,000; Full time

Job summary

Cigna Health and Life Insurance Company is seeking a Clinical Case Manager to promote clinical outcomes by assessing, planning, and coordinating services for an international caseload. The role emphasizes information, navigation, and coordination for members outside the United States, with collaboration among patients, families, physicians, and providers.

Applicants should hold nurse licensure with a BSc and MSc in Nursing, possess strong organizational and communication skills, and demonstrate

Qualifications

• Fluent in English (reading, writing, speaking).
• Nurse licensure and nursing degree(s) required.
• Strong organizational, leadership and communication skills.

Responsibilities

• Assess, plan and coordinate patient-centered case management.
• Coordinate and communicate with healthcare teams and families.
• Maintain documentation of interventions and outcomes; monitor costs and savings.
• Support utilization review and continuous education to maintain clinical expertise.

Skills

Organizational skills

Leadership

Communication

Analytical thinking

MS Office

Education

Nurse Licensure

BSc & MSc Nursing

Job description

Summary description of position

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 provide customers and clients with assistance to include " Information, Navigation and Coordination" to best meet the customers medical needs with regards to the covered benefit plan. Assistance may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans. 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 and a consumerism approach 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 the treatment plan and goals and identifies gaps in care or risks for readmission or complications.
• 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.).
• Interfaces with the member, family members/caregivers, and the healthcare team/provider, as well as internal matrix partners.
• Identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
• 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 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.
• Assists Utilization Review as needed/requested.
• 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.
• BSc & MSc Nursing
• Language skills: Fluent reading, writing and speaking English; any additional language is a plus.
• Demonstrated strong organizational and leadership skills.
• Strong interpersonal and communication skills.
• Demonstrates problem-solving and analytical skills.
• Knowledge of utilization or case management, cost containment services, managed care, insurance coverage, and financial management preferred.
• 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.
• Compliant with all accreditations, State, Federal and local mandates.
• Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
• Not being under any warning.

About The Cigna Group

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. Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.