14 days old

RN Embedded Care Coordinator - Chicago, IL or Kansas City, MO

Cigna
Memphis, TN 38103
  • Job Code
    21014268
Location: Chicago and Kansas City MO

Role will begin as a temporary work at home position. However, once permitted, the role is expected to travel to provider offices. Reliable transportation is required and flexibility to travel to various provider offices

Summary:Coordinates and manages member care related to preventative health following HEDIS and other Stars and Quality related guidelines, with single office practices and/or multiple provider practices, including health systems in the Cigna Medicare plan. Responsible for providing support to members, their families, and physicians, and health system administration in addressing medical and social concerns. Educates members to make informed personal health care decisions. Supports key matrix partners in performing strategies to improve Star quality performance. Facilitates communication between member, physician, health plan, health system and community to effectively improve Star performance by improving customer and provider engagement and experience.

Coordinate and manage member care in participating provider practices:
Under general supervision, responsible for identifying medium/ high risk members by utilizing predictive modeling reports for the assigned physician or health system practices.

Identify gaps in care and document compliance. Initiate contact with member/family, physician, and health care providers/suppliers to discuss the alternative treatment plans.

Greet members at on-site visits and assess members that need an ECC visit to assure coordination where prohibited.

Perform telephonic outreach to member in need of care coordination. Monitors and evaluates inpatient admissions and discharge census and follows through for post discharge appointments and needs.

Partner with in-office Point-of-Contact(s) to ensure member compliance and practice success:

Coordinate real-time performance measure management by communicating any updates to member health care.

Ensure that participating practices and are driving improvement on Star performance measures at the contract level.

Review data for those members that are frequent users of healthcare resources to ensure they are receiving the proper care.

Develop and maintain a process to ensure that all members in participating practices receive the screenings and services needed within the given timeframe.

Maintain detailed understanding of P4Q Program and HEDIS/STAR performance measures.

Once permitted, role will travel to doctor's offices. The role will also work a portion of the week from home.

Qualifications

  • Unencumbered RN licensure in applicable state(s) is required
  • At least 3-5 years of related experience in a healthcare environment
  • Experience working within a complex hospital health system, or large multi-specialty practice
  • Experience working with physicians/providers is a plus
  • Excellent written and oral communication skills, as well problem solving skills
  • Must have good interpersonal skills and must be customer focused
  • Highly organized and proactive ability to handle multiple tasks and set priorities and meet deadlines
  • Must be able to work independently with minimum supervision
  • Ability to travel to and work at participating practices
  • Must have good technical skills and must have intermediate knowledge of Excel and Microsoft office
  • Ability to communicate and interact well with providers
  • Medicare experience is a plus, as well as knowledge of HEDIS and STARS measures
  • Good time management skills and ability to work independently
  • Must be detail oriented
  • Requires access to high-speed broadband wired internet
  • Must be able to travel to provider offices once permitted

Preferred Qualifications: RN license in applicable state required. Medicare experience desired. Case Manager experience is preferred. CCM is a plus

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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.





Posted: 2021-09-12 Expires: 2021-10-11
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RN Embedded Care Coordinator - Chicago, IL or Kansas City, MO

Cigna
Memphis, TN 38103

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