10 days old

(RN) Healthy Pregnancy/Healthy Babies Case Manager

Cigna
Bloomfield, CT 06002
  • Job Code
    22027780
(RN) Healthy Pregnancy Healthy Babies Nurse Case Manager

Responsibilities

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

Establishes a collaborative relationship with the 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.

Negotiates fee for services, level of care, intensity and duration with providers(s), as able.

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.

Delivers utilization review services for all inpatient, outpatient, and home services throughout the duration of transplant case management services. Interacts and coordinates referrals to the Medical Directors as necessary.

Acts as a preceptor for Case Managers for training and/or performance issue, as able and as assigned.

Demonstrates evidence of continuing education, minimally 1 per quarter to maintain clinical expertise.

The Specialty Case Manager interacts with benefit specialist and claims staff for claim payment direction to ensure correct interpretation of transplant contracts and to apply payments accurately.

Assists in service marketing and/or account management functions for service center-based customers, as assigned.

Assists Sales Account Executive in communicating status and/or resolving issues for service center-based customers, as assigned. Participates on committees, task forces and other company projects, as assigned. Supports training initiatives or audits of case files, as assigned.

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

Additionally the candidate will be responsible for the adoption and demonstration of the Consumer Health Engagement cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

Qualifications

RN unencumbered licensure required

3 years clinical experience/direct patient care required

Experience in High Risk Obstetrics required

Experience in NICU required

Case management experience preferred

Managed care experience preferred

Excellent time management, organizational, research, analytical, negotiation, communication (verbal and written) and interpersonal skills.

Service marketing/account management experience a plus.

Computer skills and typing expertise

This role is WAH which allows work to be performed at home. Employees must be fully vaccinated if they choose to come onsite. Currently we are encouraging all employee to remain working from home and all onsite meetings require a virtual option. Are you willing and able to comply with our policy?

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 70,400 - 117,300 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.

We want you to be healthy, balanced, and feel secure. That's why 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) with company match, 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, visit Life at Cigna .

About Evernorth

Evernorth, Cigna Corporation's health services segment, exists to elevate health for all. We're building on our legacy and redefining health care as we know it. Unbiased in how we think, we create without limitation. We partner without constraints, deliver value differently and act in the interest of humanity. Solving across silos, closing gaps in care, and empowering clients, customers, and people everywhere to move onward and upward. When you work with us, you'll be empowered to solve the problems others don't, won't or can't. Join us. 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.

Cigna 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.





Posted: 2023-01-21 Expires: 2023-02-19
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(RN) Healthy Pregnancy/Healthy Babies Case Manager

Cigna
Bloomfield, CT 06002

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