Job Description

The Nurse will:

+ Deliver professional activities in the Case Management job family.

+ Coordinate enrollee care needs across the continuum for assigned members who are medically stable but require primary psychosocial support and acute intermittent medical support.

+ Interview members and relatives to obtain social history relevant to medical problems and care planning.

+ Assist members with environmental difficulties that interfere with obtaining maximum benefits from medical care.

+ Serve as a liaison between primary care team, members, relatives and appropriate outside agencies.

+ Apply standard techniques and procedures to routine instructions that require professional knowledge in specialist areas.

+ Provide standard professional advice and creates initial reports/analyses for review.

+ Provide guidance, coaching, and direction to more junior members of the team in Case Management

**Responsibilities include:**

+ Responsible for the effective and sufficient support of all Case Management activities to include review of inpatient and outpatient medical records for appropriateness of case management resources.

+ Uses an established set of criteria to evaluates and approve the necessity of case management services rendered.

+ Provide notification of decisions in accordance with compliance guidelines.

+ Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.

+ Works with management team to achieve operational objectives and financial goals.

+ Supports teams across CM Department and throughout Clinical Operations as needed.

+ Active participation and completion of all required trainings.

+ Maintain Required Licensures.

+ Adherence to regulatory and departmental timeframes for review of requests

+ Meet/exceed department Turn Around time, daily established productivity goals, and management of medical cases

+ Proficient knowledge of policies and procedures, Medicare, HIPAA and NCQA standards

+ Professional demeanor and the ability to work effectively within a team or independently

+ Flexible with the ability to shift priorities when required

+ Other duties as required

**Qualifications**

+ Current Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN.

+ **_State Compact LPN License Required_**

+ Minimum 3-5 years clinical experience.

+ Managed Care and Case Management experience required

+ Monday - Friday: 8:00 - 5:00 in candidates own time zone

+ Clinical Care coordination for member, assist with getting appointments, transportation, medications, disease management, etc.

+ Telephonic outreach - outbound & inbound calls

+ Have a case load of 70-75 members

+ Metrics - productivity minimum of 80 member outreaches/week

+ Calls are recorded

+ Help solve member needs within 45 days/open & close cases within 45 days

+ Must like to be on the phone and work at the computer all day

+ Experience in managed care setting preferred

+ Strong customer orientation

+ Strong organizational, planning, and communication skills

+ Working knowledge of insurance industry

+ Excellent time management skills, self-starter, and highly motivated

+ Ability to multi-task and complete various projects under tight deadlines

Knowledge, Skills, and Abilities Required

+ Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member

+ Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments

+ Able to work in a dynamic, fast-paced team environment and to promote team concepts

+ Excellent typing skills.

+ Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

**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:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._

_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._

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