Nurse Case Manager Analyst page is loaded
Nurse Case Manager Analyst
Apply remote type Hybrid locations ESP Work at Home - 39 hrs time type Full time posted on Posted Yesterday job requisition id 25004594
This position promotes the improvement of clinical outcomes for members by assisting those experiencing illness and injury through the case management process. The Clinical Case Manager assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet individual health needs within a defined population. The role involves promoting quality, cost-effective outcomes by managing care needs across the continuum, utilizing effective verbal and written communication skills, education, and health advocacy to members. Ability to work independently and communicate effectively via various channels (videoconferencing, international calls) is essential.
Position Scope:
- Manages and coordinates an active caseload of case management cases by providing information, navigation, and coordination to customers outside the United States.
Major responsibilities and desired results:
- Uses clinical knowledge to assess and establish customer-centric treatment plans, identify gaps in care, and mitigate risks for readmission or complications.
- Interacts with members, family members/caregivers, healthcare teams/providers, and internal partners.
- Maintains accurate records of case management interventions, including cost/benefit analysis, savings, and data collection.
- Evaluates medical information against criteria, benefit plans, coverage policies, and determines medical necessity.
- Builds strong working relationships with internal staff, partners, customers, and providers.
- Participates in training initiatives and demonstrates ongoing education to maintain clinical expertise and certifications.
- Adheres to professional practice standards, policies, procedures, and quality assurance standards within scope of licensure and certification.
Minimum requirements:
- Nurse Licensure.
- Fluent in reading, writing, and speaking English. Native Japanese speaker with fluency in Katakana, Kanji, and Hiragana; additional languages are a plus.
- Strong organizational, leadership, interpersonal, and communication skills.
- Problem-solving and analytical skills.
- Ability to advocate for customers while complying with policies, procedures, and legal requirements.
- Sensitivity to culturally diverse situations and clients.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, advocates for better health at every life stage. We guide customers through the healthcare system, empowering them with information to make informed health decisions. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran or military status, religion, national origin, or other protected characteristics.
If you require reasonable accommodation during the application process, please email: SeeYourselfEMEA@cigna.com. Do not email for application updates or resumes, as responses will not be provided.
About The Cigna Group
Starting with a simple decision, we are committed to changing lives.
At The Cigna Group, we aim to improve health and vitality through our divisions Cigna Healthcare and Evernorth Health Services, enhancing the lives of clients, customers, and patients.
Join us in driving growth and improving lives.
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