Nurse Case Manager Senior Analyst

• The Nurse Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs. Assistance  may include  such  activities as  providing clinical information  regarding  medical conditions or treatments, identifying  providers and  coordinating  complex care plans . The Nurse Case Manager will promote quality cost-effective outcomes managing care needs through education and health advocacy to members serviced. The Nurse Case manager is able to work independently and effectively communicate to internal and external customers by telephone, email or face to face with customers.

Major responsibilities and desired results:

• Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
• Manages/coordinates an active volume of cases by providing information, navigation and coordination to customers worldwide.
• Works with a multicultural population and is constantly aware of the cultural differences among that population.
• Establishes patient centric goals and interventions to meet the member’s needs
• Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
• Balances business needs with patient advocacy
• Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
• Contact/collaborate with providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
• 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.
• Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
• Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.
• Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations
• Maintains accurate workflow and process documents
• 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.
• Serve as clinical liaison to Clients
• Other duties as assigned

Minimum requirements:

• Bachelor in Nursing, 3-5 years of experience in international clinical management
• Very strong IT skills
• Demonstrated organizational and leadership skills
• Strong interpersonal and communication skills
• Demonstrates problem-solving and analytical skills.
• Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
• Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
• Ability to build solid working relationships with staff, matrix partners, customers and providers

Language requirements:

• English and French, Portuguese, or Arabic