Nurse Case Manager, Senior Analyst Job at Cigna

The Nurse Case Advisor uses their clinical knowledge to conduct medical necessity reviews for the clinical services recommended to our customers, confirm they are medically necessary and can be covered under the client / customer’s policy terms and conditions

• 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
• Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
• 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

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