RN Nurse Case Manager Specialist-ECF- PST or MST Time Zone job at Cigna in

Cigna is looking of RN Nurse Case Manager Specialist-ECF- PST or MST Time Zone on Wed, 27 Mar 2013 15:23:06 GMT. Job Description Responsibilities Develops and defines a structured working relationship with key partners in inpatient facilities to support regular, effective communication and exchange of information in order to manage the member's needs in compliance with all Federal/State/Facility contract and internal CIGNA requirements. Retrieves active daily census each morning and prioritizes cases for...

RN Nurse Case Manager Specialist-ECF- PST or MST Time Zone

Location: Kansas

Description: Cigna is looking of RN Nurse Case Manager Specialist-ECF- PST or MST Time Zone right now, this job will be placed in Kansas. For complete informations about this job opportunity kindly read the description below. Job Description

Responsibilities

Develops and defines a structured working relationship with key partners in inpatient facilities to support ! regular, effective communication and exchange of information in order to manage the member's needs in compliance with all Federal/State/Facility contract and internal CIGNA requirements.

Retrieves active daily census each morning and prioritizes cases for impact.

Access the approved CIGNA guidelines for inpatient review and directs communication with the facility to elicit clinical information and facilitate discharge planning.

Identified all cases appropriate for inpatient case management interventions, initiates and discusses options for discharge planning with the facility, provider, vendor, member and/or family and documents interactions and outcomes related to those actions.

Identify and build effective relationships with a network of community, government, and knowledge resources. Maintain information on those resources and share with peers as appropriate.

Act as liaison and patient advocate between account, participant, fa! mily, physician(s) and facilities/agencies. Take appropriate a! ction to ensure participant and practitioner satisfaction within benefit constraints.

Develop a participant centered plan for short term and long term objectives, including time frames for follow up. Utilize available internal and community resources in development of plan. Involve all appropriate parties (member, physician, providers, employers, etc) to determine case results/outcomes.

Provide information and resources as appropriate to empower participants to take an active role in care, treatment and cost decisions.

Implement, coordinate, monitor and evaluate the plan on a systematic, ongoing, appropriate basis.

Negotiate price and quality care levels, intensity and durations of services.

Document findings and continue to anticipate needs, determine benefit coverage status and communicate proactively to participant and members of treatment team.

Identifies new referrals for complex and specialty CM programs and coordi! nates transition to appropriate CM when necessary.

Identifies and elevates potential quality of care issues to CIGNA's Quality representatives for follow up determination.

Works to identify gaps in care and resolution of those identified and prevention of future gaps in care.

May be required to participate in customer and auditor visits.

Participates in special projects as deemed necessary.

Other duties as required and related to this role.

Must be available to work Arizona hours.
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Requirements

Qualifications

2 -3 years RN clinical experience in inpatient or managed care setting

Demonstrated ability to anticipate, plan, coordinate and organize.

Knowledge of community, state and federal resources.

Possession of a valid driver¿s license, proof of insurance, good driving record and reliable transportation.

Strong skills in teamwork, negotiation, conflict m! anagement, problem solving, and effective decision making.

Exp! erience in medical management and case management in a managed care setting or hospital is highly desirable.

Ability to assess complex issues, recommend changes and resolve problems.

Knowledge of managed care products and strategies.

Ability to work within changing business environment and balance business needs with patient advocacy.

Experience managing multiple projects in a fast paced matrix driven environment.

Effective at negotiation, teamwork and cooperative relations with diverse internal and external stakeholders .
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Cigna.

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This job starts available on: Wed, 27 Mar 2013 15:23:06 GMT

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