RN Nurse Case Manager -Onsite - Laredo, Texas - Sign- on -Bonus Available $1000.00 - Case Management
Company: Cigna
Location: Harlingen
Posted on: May 26, 2023
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Job Description:
RN Nurse Case Manager -Onsite - Laredo, Texas - Sign- on -Bonus
Available $1000.00Primary Function:
Coordinate and manage relationships with participating provider
practices. Maintain detailed understanding of HEDIS / STAR
performance measures. Develop and maintain a process to ensure all
customers in participating provider practices meet all quality
metrics. Responsible for coordinating the delivery of
cost-effective, quality -based health care services for health plan
customers by development and implementation of alternative
treatment plans that address individual needs of the customer,
their benefit plan, and community resources. Plans, implements, and
evaluates appropriate health care services in conjunction with the
physician treatment plan. Utilizes clinical skills to assess, plan,
implement, coordinates, monitor and evaluates options and services
in order to facilitate appropriate healthcare outcomes for
customers. Responsibilities:
* Identifies gaps in needed quality metrics for customers and
communicates to provider
* Maintains physical presence in participating provider practices
--- Identifies high-risk/high-cost patients for possible case
management intervention.
* Interfaces with providers of medical services and equipment to
facilitate effective communication, referrals, development of
discharge planning, and alternative treatment plan development.
* Identifies customer needs, coordinates and supports planned and
unplanned transitions and post discharge follow up calls which may
include primary care physician and specialist appointment
scheduling
* Collaborates with the attending physician to achieve identified
patient outcomes.
* Attend and participate in weekly Complete Health Team rounds
* Perform telephonic outreach or home visits, as needed
* Communicates with all departments to resolve issues or document
trends.
* Understands and follows administrative guidelines (policy and
procedure) of the unit.
Experience:
* Current Licensure as a Registered Nurse or Licensure Practical
Nurse, in the state of Texas in good standing.
* Associates degree, diploma or B.S. in Nursing
* Three to Five (3-5) years recent experience in an acute-care
environment, case-management or utilization management position
(experience can be a combination of LVN/RN licensure)
* Previous HEDIS and/or CMS STARs experience a plus
* Attends and actively participates in staff meetings.
* Other Duties as assigned. Supervisory Responsibilities: --- None
Job Related
* Works independently with minimum of supervision --- Bilingual -
preferred Spanish both conversational and written
Skills:
* Verbal and written communication skills
* Interpersonal skills
* Basic Mathematical and statistical ability
* Organizational skills
* Typing and computer knowledge- able to type 35WPM
* Knowledge of utilization review requirements and procedures
* Knowledge of current health care practices and appropriate
treatments. --- Knowledge of community resources
* Ability to travel to and work at participating provider
offices
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.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for
better health through every stage of life. We guide our customers
through the health care system, empowering them with the
information and insight they need to make the best choices for
improving their health and vitality. Join us in driving growth and
improving lives.
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.
The Cigna Group 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.
Keywords: Cigna, Harlingen , RN Nurse Case Manager -Onsite - Laredo, Texas - Sign- on -Bonus Available $1000.00 - Case Management, Executive , Harlingen, Texas
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