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Job Description Embedded Care Coordinator Nurse Case Manager
Coordinate and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality of care is maintained. Provides clinical assessments, health education, and utilization management to customers. Performs community visits or telephonic outreach to customers that have been identified for case management. Nurse Case Managers also focus on risk identification, outreach, developing and implement care plans, follow ups, and assist with coordination of benefits when needed.
Job Related Skills:
Verbal and written communication skills
Basic Mathematical and statistical ability
Typing and computer knowledge- able to type 35WPM
Knowledge of utilization review requirements and procedures
Knowledge of current health care practices and appropriate treatments.
Knowledge of community resources
Ability to travel to and work at participating provider offices
Works independently with minimum of supervision
Bilingual preferred Spanish both conversational and written
Experience and Minimum Requirements:
Current Licensure as a registered nurse, in the state of Texas in good standing.
Associates degree, diploma or B.S. in Nursing
Five (5) years recent experience in an acute-care environment, or
Two years (2) years recent experience in a case-management or utilization management position
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.
If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.