Nurse Case Management Senior Analyst
hace 5 días
**KEY AREAS**:
Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
- Manages/coordinates an active volume of cases by providing information and coordination to customers worldwide in a multicultural population.
- Establishes patient centric goals and interventions to meet the member’s needs.
- Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
- Balances business needs with patient advocacy.
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
- Coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
- Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans.
- Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.
- Coordinate care with other nurses around the world when a need for local or regional expertise is important for better care or to comply with regulations.
- Maintains accurate workflow and process documents.
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Serve as clinical liaison to Clients.
**SKILLS AND KNOWLEDGE**:
- Bachelor in Nursing, 3-5 years of experience in international clinical management.
- Languages required: English, and native Portuguese.
- Desirable: experience in chronic condition management (diabetes, cardiovascular disease) and occupational health or oncology.
- Demonstrated organizational and leadership skills.
- Strong interpersonal and communication skills.
- Demonstrates problem-solving and analytical skills.
- Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements.
- Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
- Ability to build solid working relationships with staff, matrix partners, customers and providers.
**What we require**:
- You are able to commit to 39 hour/week.
- You are available to work one of this shifts - Monday to Friday 12:15 to 20:03.
- Available to start asap.
**What’s in it for you?**
We recognize we wouldn’t be where we are today without our employees, that’s why we offer such excellent benefits designed to suit you as and when you need them:
- Hybrid role.
- Permanent contract.
- IT Kit - We will set you up with home working resources.
- Flexible dress code - It’s not about what you wear, it’s about what you can do so why not be comfortable doing it.
**What makes Cigna different from other employers?**
We go further than just paying insurance claims. Solid customer relationships are our main goal. We also strongly believe in business ethics and continually strive to be cleaner, greener, and respectful of all.
We owe our success to the talent and dedication of our team. They’re the ones who make a difference in our customers’ lives. So we know that it’s important to go the extra mile for our employees. We make sure they have a good work-life balance and we offer many initiatives for health and well-being.
Plus much more
**About Cigna Healthcare**
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
- 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._
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