Nurse Case Manager (FT Queue) - Evernorth Health Services -Remote

Nurse Case Management Lead Analyst (Full-Time, Remote)

• Full-time, remote Telephonic/Digital RN Case Manager role supporting members through inbound outreach and care coordination. A private, secure workspace in the home is required to protect confidential information.

Schedule (Eastern Time)

• 9:30 a.m.–6:00 p.m. ET
• 10:00 a.m.–6:30 p.m. ET
• 10:30 a.m.–7:00 p.m. ET

Key Responsibilities

• Obtains informed consent per policy, including verbal consent and required written authorization.
• 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.
• Implements, coordinates, monitors and evaluates the case management plan on an ongoing basis in collaboration with the client and treating providers as appropriate.
• Documents findings in a clear concise manner and continues to evaluate medical necessity of frequency, intensity and length of care with physician(s) and agency/vendor(s) on an ongoing basis.
• Acts as liaison between account, client/family, physician(s) and facilities/agencies.
• 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.
• Acts as a preceptor for Case Managers for training and/or performance issue, as able and as assigned.
• Demonstrates sensitivity to culturally diverse situations and member needs; performs other duties as assigned 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.

Additional Responsibilities (Queue Role)

• Responsible for receiving all inbound telephonic calls from Personal Advocate, auto-dialer and other internal call transfers.
• Manages a high volume of inbound calls; maintains scheduled availability; completes call documentation and after-call work within required timeframes.
• Works effectively in a fast-paced environment; applies critical thinking; demonstrates proficiency with required systems and tools.
• Meets established quality and productivity expectations, including engagement goals, in alignment with program requirements.
• Will be responsible for identifying and addressing any immediate customer concerns, researching and providing solutions, when possible, along with assessing customer for ongoing complex case management needs and assigning to a client-based CM for further management when appropriate.
• Must be skilled in utilization of Cigna resources when identifying need for further customer support.
• Be organized, knowledgeable and thorough while promoting quality case effective outcomes, and provides quality, cost effective alternatives to acute care.

Qualifications

• Active, unrestricted Registered Nurse (RN) license in state of residence.
• Minimum of two years of direct patient-care experience as an RN
• One year of experience as a Cigna Complex or Specialty Case Manager, meeting role expectations and performance metrics.is required
• Excellent time management, organizational, research, analytical, negotiation, communication (verbal and written) and interpersonal skills.
• Proficient with computers and case management systems; able to communicate with customers while documenting in real time.
• Must meet Cigna internet and work-at-home requirements

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.

For this position, we anticipate offering an annual salary of 77,500 - 129,100 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.