RN Nurse Case Management Senior Analyst, Work from Home, Anywhere USA, (Compact License Required)

This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury. The 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 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 in a telephonic environment.  

Position Scope:

• Manages/coordinates an active caseload of case management cases for Cigna Medicare. Uses clinical knowledge to assess the treatment plan and goals, and identifies gaps in care or risks for readmission or complications.
• Establishes patient centric goals and interventions to meet the member’s needs
• Interfaces with the member, family members/caregivers, and the healthcare team, and embedded care coordinator as well as internal matrix partners.
• Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers

Major responsibilities and desired results:

¨Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.

• Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
• Promote consumerism through education and health advocacy.
• 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), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
• Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
• Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Demonstrates sensitivity to culturally diverse situations, clients and customers.

Requirements:

• Active unrestricted Registered Nurse (RN) license in state of residency. Two years full-time equivalent of direct clinical care to the consumer
• Compact Nursing License Required
• Within three (3) years of hire as a case manager, the case manager …