BackPosted on 10/05/2016
Full time |
Salary type not mentioned
Salary not mentioned |
The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs. Assistance may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans . The Case Manager will promote quality cost-effective outcomes managing care needs through education and health advocacy to members serviced. The Case manager is able to work independently and effectively communicate to internal and external customers in a telephonic environment. He/she manages/coordinates an active caseload of case management cases by providing Information, Navigation and Coordination to Customers worldwide. He/she works with a multicultural population and is constantly aware of the cultural differences among that population.
Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
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
Bachelor in Nursing, 3-5 years experience in 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
You are fluent in French and English and at least one other language.
A challenging job in an international and growing enterprise.
A dynamic, young and entrepreneurial company culture that values and stimulates initiative.
Attractive salary conditions with extralegal benefits
Bachelor in Nursing
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