Bilingual Nurse (RN) Case Management Lead Analyst - ( Dari/ Pashto) - Evernorth Health Services - Remote (Open)

Bilingual Nurse Case Management Lead Analyst -Remote -Full-Time

Required Work Hours: 9:00 a.m.-5:30 p.m. PST.

Major Job Responsibilities and Required Results for CM:

• Obtains informed verbal consent and takes all steps to obtain written consent.

• Acts with speed and purpose to identify, support and resolve customer healthcare needs.

• Establishes a collaborative relationship with the Customer, client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care.

• Sets a plan for short-term and long-term goals, time frames for follow-up, resources available (internal and community), involves all appropriate parties (client, physician, providers, employers, etc), and identifies anticipated case results/outcomes and criteria for case closure.

• Promotes quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and consumerism approach through education and health advocacy to our customers

• Implements, coordinates, monitors and evaluates the case management plan as appropriate.

• Documents findings in a clear, concise, and accurate manner.

• Acts as liaison between account, client/family, physician(s) and facilities/agencies.

• Builds solid working relationships with internal team members and across Picerno organization.

• Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.

• Adheres to quality assurance standards and all case management policy and procedures.

• Demonstrates sensitivity to culturally diverse situations, clients and customers. Any other assigned tasks as deemed necessary to meet business needs.

• Ensures the member’s privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards.

• 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

• Complies with all accreditation, State and Federal mandates.

• Completes training as required per role and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate

• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

Additional Roles and Responsibilities Specific to CM Role:

• Will manage a large volume of outbound calls, are required to be available during all scheduled times, and manage calls and after call work in a timely manner.

• Must like fast paced work, be able to thinking critically and demonstrate system proficiency.

• Must be a high performing CM with engagement rates at or above goal.

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