posted

30+ days ago

Location

Doral, FL

Description

Bilingual Nurse Case Manager

Duties

Under general supervision, Bilingual Registered Nurse (RN) Case Manager will provide telephonic and/or field-based case management services to members primarily identified as moderate or high risk patients and their caregivers to help them address their medical concerns. The RN Case Manager will work in conjunction with the medical and behavioral health interdisciplinary teams to improve the member’s medical outcomes.

Responsibilities will include, but are not limited to the following:

  • Conduct assessment with members or authorized representatives to obtain relevant medical history
  • Develop and implement member centric care plans that address health needs of the member
  • Ensures ongoing identification of barriers to care plan and ensures goals are being met by using appropriate nursing interventions
  • Provide clients with health education and linking to available community resources
  • Participate in Interdisciplinary Care Team (ICT) meetings to gain insight from health services leadership, medical directors, pharmacists, co-workers, etc. to provide effective and quality healthcare.
  • Collaborate with the Inpatient Utilization Management team to ensure appropriate and safe transitions of care as well as safe discharges.
  • Coordinate care with other members of the behavioral/medical interdisciplinary team
  • Maintain appropriate productivity and ability to manage large caseloads while meeting deadlines.
  • Identify members with status changes and notify immediate supervisor for appropriate interventions
  • Assists with the implementation of quality improvement initiatives, including, but not limited to STARS and HEDIS measures as well as Quality Improvement Plans.
  • Understand and follow policies and procedures

Qualifications

Required

  • Unrestricted Registered Nurse license
  • Two years of experience as a licensed RN in a clinical or case management setting.
  • Excellent communication and interpersonal skills.
  • Strong time management and organization skills.
  • Fluent in spoken and written Spanish and English

Preferred

  • Strong knowledge of Medicare, Medicaid, and managed care practices and benefit guidelines.
  • Two or more years of case management, discharge planning, and/or utilization review experience.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make?  To see our culture in action, search #TeamCigna on Instagram.

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.