Cigna RN Field Nurse Case Manager ( Cooke, Fannin, Grayson and Montague Counties) Tyler, Texas in Tyler, Texas
•Works with member, member’s family, and providers to develop and actuate a fully comprehensive individualized service plan.
•Conducts a fully comprehensive in-person and/or telephonic member assessment using the state mandated assessment tool per state and national guidelines, policies, procedures, and protocols.
•Conducts health risk assessments and other member assessments.
•Uses clinical judgment to identify physical and behavioral health needs and works with the member and caregiver to establish an appropriate plan of care and services that minimize needs based on medical necessity criteria and benefit guidance.
•Works with member to close clinical and pharmacy gaps in care and to mitigate non-clinical barriers to care.
•Acts as a liaison for the member and facilitates the coordination of benefits, resources, healthcare providers, and institutions.
•Completes and files all assessments and implements the care plans within the determined deadline.
•Maintains a maximum weekly face to face visit schedule of seven members for field-based nurse coordinators, average caseload of 125.
•Create and maintain a professional and supportive relationship with the patient, provider, and office staff.
•Facilitates appropriate member referrals to special programs such as Disease Management, Behavioral Health, Advanced Illness, and Social Services.
•Provides education to members regarding health care needs and available services.
•Works to facilitate member compliance with their care/treatment plan, and to ensure continuity of care.
•Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plans.
•Documents all care coordination activities and interventions in the member’s health plan clinical record.
•Maintains a focus on timely, high-quality customer service.
•Current, unrestricted RN license in the state of Texas
•Graduate of an accredited school of nursing.
•Must have current licensure as a Registered Nurse (RN) in the State of Texas.
•Reliable transportation, valid and unrestricted driver’s license, proof of insurance, and the ability to travel to member’s home, other locations within the service delivery area.
•Verbal and written communication skills.
•Must have Microsoft Office experience (Word, Excel, PowerPoint, etc.). Must be comfortable working with spreadsheets.
•Must be able to travel to members home within the service delivery area – may require up to a minimal of 1 hour radius or more for travel.
Preferred Requirements: Previous STAR PLUS experience. Home Health case management experience with Medicare or Medicaid populations plus one year experience managing members with chronic disease processes and one year experience working with community resource organizations preferred. Experience with care management software applications preferred.
Primary Location: Tyler-Texas
Work Locations: 100 East Ferguson St Suite 302 Tyler 75702
Job: Med Mgt--Case Management
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 75 % of the Time
Job Posting: Aug 10, 2018, 12:37:49 PM
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com