Deliver specific delegated tasks assigned by a supervisor in the Case Management job family.
Handle moderately-complex cases.
Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
Ensure that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
Evaluate, recommend, and maintain close relationship with inpatient and outpatient counseling/treatment facilities.
Evaluate patient counseling and treatment needs and makes recommendation on changes or additions to appropriate programs.
Manage own caseload and coordinates all assigned cases.
Complete day-to-day Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.
Tasks involve a degree of forward planning and anticipation of needs/issues.
Resolve non-routine issues escalated from more junior team members.
Position will require on-site visitations to facilities located throughout Staten Island, Bronx, Manhattan, and Queens. The specific facility assignment is to be determined. When not working on-site, can work remote.
This role is patient facing & you must be fully vaccinated OR be required to undergo testing twice a week. Note, in some locations local law requires the clinician to be vaccinated with no testing option, in those locations local law takes precedent.
Education and License Requirements:
Bachelor or Associate Degree in Nursing required. Masters Degree in Nursing preferred.
Current unrestricted Registered Nurse license for the state of New York as well as valid nursing license in the state of residence.
Experience
Minimum 5 years clinical experience with at least 3 years managed care experience preferred.
2 - 4 years' experience in utilization management preferred.
Home health, SNF, and/or rehab experience desired
Medicare/Medicaid managed care programs preferred
Position is full-time during core business hours. May require weekend and holiday rotation.
Ability to sit at a desk 50% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day; walking and standing
Dependable and reliable work schedule is essential
Required Skills:
Time-management : Ability to effectively manage one's time and resources to ensure that work is completed efficiently Excellent organizational skills
Communication : Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership
Critical-Thinking/Decision-making : Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities
Autonomy : Ability to work independently with little to no supervision
Proficient in computer literacy skills with ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint with ability to type 30 wpm preferred
Experience using videoconferencing systems such as WebEx
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.
