RN-Care Manager-Evernorth-Colorado

The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

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We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

Clinical Integration

• Identifies and builds effective relationships with local network providers.
• Works effectively with CareAllies's internal team to support coordination of care and data analysis.
• Thoroughly reviews patient level actionable data to support identification of eligible customers and creates processes and procedures for outreach and engagement.

Health Information Line follow up calls

Outreach to customer with a Steerable ER visit

Outreach to customers with Out of Network spend

• Drives appropriate outreach, engagement, and positive clinical outcomes through timely information exchange with matrix partners.
• Acts as a primary liaison for the customer, partnering with internal programs (i.e. complex case management, specialty case management), external programs (i.e. community providers, specialists), and all matrix partners to support positive outcomes.
• Establishes and maintains a positive, professional, and collaborative relationship with customer/employee, employer, providers of care, and partners to support improved outcomes (clinical, quality and cost) of aligned employee population.
• Develop and implement engagement strategies defined by identified population needs.

Care Coordination

• Supports care coordination for individual customers, focusing on the high-risk targeted population to ensure efficient, high-quality, and cost-effective care.
• Provides steerage and referrals to high quality network providers.
• Refer appropriate individuals to eligible programs within CareAllies and all eligible client specific health and wellness programs.

Patient Engagement

Coaching

• Enhances customers' abilities to interact effectively with their providers.
• Provide education and research relevant topics as needed to support customer inquiries.
• Collaborates with customer in creation of care plan, establishing goals and interventions, and documents plan in medical management system.
• Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being. 
• Communicates effectively through verbal and written modes of interaction, including telephonic, email, text, and direct messaging.
• Identifies gaps in care and works with customers, providers, and/ or local community resources to close gaps in care.
• Acts as resource to direct customers with specific non-clinical questions to the appropriate resource.

Benefit Navigation

• Refer to client contact for detailed plan questions, concerns, and issues requiring escalation.
• Education and referrals to plan clinical programs and resources (internal and external).
• Assist employees with health care professional referrals, (e.g., primary care physician or specialist referrals in the plan network).

• ·        Current Licensure as a registered nurse, in the state of residency, in good standing. 

  ·        Associates degree, diploma or B.S. in Nursing 

  ·        Three to Five (3-5) years recent experience in an acute-care environment, case-management or utilization management position (experience can be a combination of LVN/RN licensure)  

  ·        Effective written and oral communication skills with individuals as well as group settings 

  ·        Ability to focus, organize and prioritize delivery of services 

  ·        Ability to work without direct supervision   

  ·        High energy level, with dynamic presentation skills is required 

  ·        Positive role model in demonstrating healthy behaviors  

  ·        Passion for health improvement 

  ·        Ability to proactively collaborate professionally with the client and other matrix partners. 

  ·        Understand and own a variety of clinical targets and outcome measurements. Develop action plans that drive value for the customers and clients.   

  ·        Proven administrative abilities, with proficiency in Microsoft Word, Excel and PowerPoint, and ability to conduct online research. 

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 76,600 - 127,600 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.