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. IN addition to Case Management duties, the Case Manager will manage precert and concurrent reviews for the transplant members assigned to their caseload. This will require review of clinical information and correspondence with facilities to make determinations on transplant requests.

Major responsibilities and desired results:

• 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.

• Collaborate with Facilities and Health Care Providers telephonically to obtain clinical information

• Perform precert and concurrent reviews for transplant members

• Manage own caseload and coordinate all assigned cases.

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

• 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.

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.

Qualifications:

Active unrestricted Compact Registered Nurse (RN) license in state or territory of the United States

Two years full-time equivalent of direct clinical care to the consumer CCM Certification preferred

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.