Nurse Case Manager

Cigna - Bloomfield, CT

Full-time

Bloomfield, CT

Insurance Carriers and Related Activities

About the position

The Nurse Case Manager will play a crucial role in improving health outcomes for members through effective case management. This position involves assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare options and services tailored to individual health needs. The Case Manager will utilize strong communication skills and a consumerism approach to advocate for members, ensuring quality and cost-effective care throughout the continuum of care.

Responsibilities

• Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
• 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.

Requirements

• Active unrestricted Registered Nurse (RN) license in state of residence.
• Must possess a Compact RN license.
• Two years full-time equivalent of direct clinical care to the consumer.

Nice-to-haves

• Previous case management experience with the Medicare/Medicaid population, specifically focusing on Special Needs Plan.
• Knowledge of community resources.
• Knowledge of managed care preferred.