Nurse Case Manager Analyst

Cigna; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player seeks a Clinical Case Manager to enhance clinical outcomes for members. This role involves assessing, planning, and coordinating care for individuals, ensuring quality and cost-effective solutions. You'll utilize your clinical expertise to develop customer-centric treatment plans while advocating for patients' needs. Join a dynamic team dedicated to improving lives and navigating the healthcare landscape with compassion and professionalism. If you're passionate about making a difference in healthcare, this opportunity is perfect for you.

Qualifications

• Nurse Licensure required with fluency in English and Japanese.
• Strong organizational, leadership, and communication skills are essential.

Responsibilities

• Manage and coordinate an active caseload of case management cases.
• Evaluate medical information against criteria and determine medical necessity.

Skills

Clinical Knowledge

Communication Skills

Organizational Skills

Problem-Solving Skills

Analytical Skills

Cultural Sensitivity

Education

Nurse Licensure

Job description

This position involves managing the case management process to improve clinical outcomes for members and assist those experiencing illness and injury. The Clinical Case Manager will assess, plan, implement, coordinate, monitor, and evaluate options and services to meet individual health needs within assigned caseloads of a defined population, considering business perspectives. The role promotes quality, cost-effective outcomes by managing care needs throughout the continuum of care, utilizing effective verbal and written communication skills for education and health advocacy to members. The ability to work independently and communicate effectively with internal and external customers through various channels (such as videoconferencing and international phone calls) is essential.

Position Scope:

• Manages and 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 identify gaps in care or risks for readmission or complications.
• Interacts with members, family members/caregivers, healthcare teams/providers, and internal matrix partners.
• Maintains accurate records of case management interventions, including cost/benefit analysis, savings, and data collection.
• Evaluates medical information against criteria, benefit plans, coverage policies, and determines medical necessity.
• Builds solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers.
• Participates in unit and corporate training initiatives and maintains clinical expertise and certification through continuing education.
• Adheres to professional practice standards within scope of licensure and certification, quality assurance standards, and all case management policies and procedures.

Minimum Requirements:

• Nurse Licensure.
• Language Skills: Fluent in reading, writing, and speaking English; native Japanese speaker with fluency in Katakana, Kanji, and Hiragana; additional languages are a plus.
• Strong organizational and leadership skills.
• Excellent interpersonal and communication skills.
• Problem-solving and analytical skills.
• Ability to act as an advocate for the customer while ensuring compliance with policies, procedures, and legal requirements.
• Sensitivity to culturally diverse situations, clients, and customers.

About Cigna Healthcare:

Cigna Healthcare, a division of The Cigna Group, advocates for better health at every life stage. We guide customers through the healthcare system, empowering them with information and insights to make informed health decisions. Join us to drive growth and improve lives.

Qualified applicants will be considered regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, public assistance status, citizenship, or other protected characteristics.

If you require reasonable accommodation to complete the online application, please email: [e-mail]. Do not email this address for application updates or resume submissions, as responses will not be provided.