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Nurse Case Management Senior Analyst – Cigna – Antioch, TN

So, you’re interested in becoming our newest Nurse Case Management Senior Analyst , huh? Great choice! We know you don’t have a lot of time, so we’ll be brief….

Are you all about the follow up and follow through, juggling multiple tasks and knowing what things need to be completed?

Do you thrive in a fast-paced, collaborative environment that focuses on delivering great customer service for our clients and customers alike?

Can you use your analytical skills to quickly make decisions, followed by communicating with clients and customers with empathy and sincerity?

First things first, we’re a global health service company dedicated to helping people improve their health, well-being and sense of security. But we don’t just care about your well-being, we care about your career health too. That’s why when you work with us, you can count on a different kind of career – you’ll make a difference, learn a ton, and share in changing the way people think about healthcare. #Winning

Now on to the good stuff… what you’ll do:
The two major functions of the Post-Acute Care Case Manager (PACCM) are to ensure the customer is at the appropriate level of care, and to initiate and follow through in the discharge planning process. Given the complex nature and challenges of the US health system and CMS compliance requirements, it is necessary to provide case management interventions that are flexible, aligned with provider and facility plan of care, and follow the most effective work approaches.

Post-Acute Care Case Managers are expected to be able to perform at the top of their license . It is essential that clinically licensed personnel understand health plan benefits, demonstrate good clinical judgment, show initiative and critical thinking skills, and most importantly, follow up and follow through to ensure the best outcome for the customer.

In addition, each Post-Acute Care Case Manager takes an ownership approach in their individual role and responsibilities, and at the same time, understands the value of being a good team member. Cigna-HealthSpring Post-Acute Care Case Managers are one part of a clinical interdisciplinary care team that involves plan physicians and partners, Medical Directors, Community Case Managers, Acute Care Case Managers, Pre- certification nurses, Embedded Care Coordinators (P4Q), and specialists.

As with any Cigna-HealthSpring team member the Post-Acute Care Case Manager is a good steward of health plan resources, and consistently represents our company in a positive manner (i.e., follows dress code and demonstrates customer service principles).

Position Scope/responsibilities

Initiate/update member care plans.

Major Job Responsibilities

Utilization Management- manages initial preservice organizational requests for transitions to post-acute facilities.

Performs concurrent review.

Medical Director Rounds/Reviews- present complex cases in a clear, concise, and efficient manner.

Discharge Planning- perform assessments during admissions to assist with needs post discharge and develop appropriate plan for discharge.

Develop and maintain effective working relationships with health plan partners and customers.

Maintain compliance with CMS regulatory guidelines regarding determinations.

Contribute as an active participant in the company’s STAR initiatives

Minimum requirements

Must be a current contractor with Cigna or Express Scripts

Active RN license with no restrictions

Greater than 3 years of clinical nursing experience

Minimum experience with Microsoft office

Ability to enter data and documentation into an electronic platform

Strong communication skills

Preferred requirements

Must be a current contractor with Cigna or Express Scripts

Utilization management experience

Case management or disease management experience

Experience working in skilled nursing setting.

Experience working directly with physicians.

Strong knowledge of CMS guidelines for post-acute utilization

Knowledge of HEDIS/NCQA standards

Experience using Interqual criteria

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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

Source: Indeed.com
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