Summary

The Clinical Care Manager RN is an integral member of the Care Management department as part of Cigna Medical Group's Population Health Improvement Team (PHIT). The PHIT is comprised of care management, clinical pharmacy, behavioral health, and clinician coaches who support Cigna Medical Group (CMG) Healthcare Centers and clinicians to improve the health of the patients we serve, with a focus on the management of high- and rising-risk, disease burdened members enrolled in Cigna Healthcare of Arizona health plans.

The Clinical Care Manager RN utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. The Clinical Care Manager RN ensures that program objectives are met and supports patients and physician practices in coordinating patient care through transitions, barriers to care, and education. This role additionally connects patients to programs and services as available through Cigna Medical Group, Cigna Health Plans, and within the community. This position manages a panel of patients coordinating services with them and has oversight of the licensed practical nurses (LPNs) on the team. This role provides disease management and ongoing follow-up of members with Congestive Heart Failure, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease (other conditions may be identified based on patient need).

Clinical Responsibilities and Essential Functions

Care Coordination: Coordinates the care of the high-risk, post transition and targeted populations in appropriate, efficient and cost-effective manner. Assists patient to arrange timely access to services, evaluates social/financial/environmental support adequacy in a culturally sensitive manner.

Care Planning: Collaboratively creates/updates care plans for care transitions, disease management, and other as needed. Evaluates the effectiveness/relevance of the treatment plan and communicates with the primary care provider and health care delivery team. Seeks input from health care team members and physicians as able in order to update care plan. Prepares for and participates in Care Team huddles/meetings to problem solve around highly complex care needs.

Disease Management/Outreach: Initiate new customer and ongoing telephonic connections per protocol for an identified caseload. Build care relationships among patient/caregivers. Complete post-discharge calls to all identified patients to facilitate and oversee discharge planning "coordination of care" needs, identifying and closing gaps in care, and providing education within specified timeframes.

Use of Internal/External Resources: Identifies and refers appropriate patients to eligible programs within CMG and respective Cigna Healthcare of Arizona health plans. Review and inform the patient/caregiver around options for care, use of benefits and community resources. Act as the community resource expert for patients/practices for high-risk members, including transition of care/hospice resources, direct acute admits, direct skilled nursing admits, home health/infusion needs and durable medical equipment. Serve as the contact point, advocate and informational resource for patient/caregiver. Utilize known community resources to link patient with services/programs available.

Clinical Knowledge: Maintains current knowledge base on the critical elements of the target population such as disease states, quality standards, utilization patterns, clinical treatment guidelines. Targeted disease states include but are not limited to COPD, CHF, DM, and depression. Coordinates and identifies high-risk population with a history of poly-pharmacy, to improve quality outcomes with appropriate support services in managing pharmacy needs.

Documentation: Maintains appropriate documentation and tracking as required by Cigna and the PHIT Department.

Other duties: Fulfills the need of clinical supervision of the LPN reviewing care plans and assessment of patient's needs. Represent PHIT department as a member of a cross-functional project team. Other duties as assigned.

Minimum Qualifications

• Current AZ RN License required
  
  


• Minimum of 4 or more years nursing experience is preferred
  
  


• Experience in cardiac/pulmonary/diabetes nursing preferred
  
  


• Case Management/Care Coordination/Disease Management experience preferred
  
  


• Certification in related field preferred
  
  


• Excellent oral and written communication skills,
  
  


• Experience with electronic health record documentation
  
  


• Experience with cross-functional team collaborations, workflows, and process improvement
  
  


• Strong competencies in Microsoft Word and Excel
  
  


• Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly
  
  


• Demonstrate commitment to ongoing education.
  
  


• Must we willing and able to travel to all affiliated Practice locations.
  
  


• Demonstrated ability in working with Licensed Practical Nurses as part of the care delivery team.
  
  

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About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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.