Major responsibilities and desired results:
- Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
- Wil work across IO, GEH and GIH segments
- Manages/coordinates an active volume of cases by providing information, navigation and coordination to customers worldwide.
- Works with a multicultural population and is constantly aware of the cultural differences among that 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.
- Visit providers to manage and 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 from other regions 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.
- Demonstrates sensitivity to culturally diverse situations, clients and customers.
- Serve as clinical liaison to Clients
- Other duties as assigned
Minimum requirements:
- Bachelor in Nursing, 3-5 years of clinical experience ideally, in international clinical management
- 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
Language requirements:
- English, French & Arabic: read, write and speak fluently
APPLY USING THE LINK BELOW:
French & Arabic Speaking Nurse Case Manager Analyst at Cigna
