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Cigna (RN) Inpatient Nurse Case Manager (California) in Bloomfield, Connecticut

(RN) Inpatient Nurse Case Manager (California)

This is a remote, work at home role in California

Role Summary:

Provides advanced professional input to complex Nurse Case Management assignments/projects. Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required.

Major Duties:

Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.

Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves.

Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.

Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.

Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.

Additionally the candidate will be responsible for the adoption and demonstration of the Consumer Health Engagement cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

Qualifications:

RN with current unrestricted CA state licensure required.

Must reside in the state of California

Minimum of three years clinical experience/ direct care required

Utilization management experience required

2 years case management experience strongly preferred

May require experience with short or long term disability and knowledge of workers' compensation regulations.

Excellent communication and interpersonal skills.

Excellent time management, organization and negotiation skills.

Strong research and analytical skills.

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

Knowledge of managed care preferred.

Works independently, receiving direction from manager for new or unprecedented situations.

Manages own caseload and coordinates all assigned cases.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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 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.

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