Job Id 23012988
Hours: Must be able to rotate day shift hours and work until 6 p.m. or 7 p.m.
The Transplant Case Manager interacts with benefit specialist and claims staff for claim payment direction to ensure correct interpretation of transplant contracts and to apply payments accurately.
Assists in service marketing and/or account management functions for service center-based customers, as assigned.
Assists Sales Account Executive in communicating status and/or resolving issues for service center-based customers, as assigned.
Participates on committees, task forces and other company projects, as assigned.
Supports training initiatives or audits of case files, as assigned.
Demonstrates sensitivity to culturally diverse situations, clients and customers.
Any other assigned tasks as deemed necessary to meet business needs.
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.
Case managers are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers, families, and caregivers to assist with navigating through the healthcare journey.
Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.
- Customer Strong: I deliver world-class experiences for all my customers.
- Me to We: I take accountability to trust, partner, and deliver.
- Own It: I see a need and deliver value because I care.
- Evolve and Adapt: I learn and adapt to meet evolving business needs.
- Be Bold: I pioneer and think broadly to solve challenges.
- Take Care: I prioritize self-care and act with compassion toward colleague.
Day in the Life Responsibilities
- Collaborates with customer in creation of care plan and documents plan in medical management system.
- Partners with each customer to establish goals and interventions to meet the customer’s needs.
- Establishes plan of care in conjunction with the customer and provider then document into a medical management system.
- Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
- Empowers customers with skills to enhance interaction with their providers.
- Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
- Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer’s provider and other Cigna Medical Management programs to provide whole-person health support.
- Tracks daily activities to trend volume and outcomes.
- Follows standard operating procedures.
- Toggles between multiple systems and applications.
- Research relevant topics in health promotion and disease prevention, as required for specific customers.
- Prioritizes work to meet commitments aligned with organizational goals.
- Understands and adheres to Case Management performance measures to deliver on key results.
- Completes training within the communicated time limit as required per role.
- Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Minimum of two years full-time direct patient care as an RN required.
- For Specialty Case management positions, experience in the specialty (i.e., NICU, Transplant, Oncology, Maternity) preferred.
- Must have an active and unencumbered RN License
- Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.
- Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
- Skilled in clinical acumen to form a judgement and act.
- Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.
- Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
- Demonstrates sensitivity to culturally diverse situations, participants, and customers.
- Demonstrates effective organizational skills and flexibility to meet the business needs.
- Adapts approach and demeanor in real time to match the shifting demands of different situations.
- Ability to manage multiple, complex situations in a fast-paced environment collaborating with clinical and other business partners.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 70,400 – 117,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
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