Nurse (RN) Case Management Lead Analyst at Cigna in Bloomfield, Connecticut

Job Description:

Shift: Must be flexible to work Days or Evenings. Mon-Fri

This is a full-time and work-at-home Telephonic/Digital RN Case Manager. Employees must conduct business in a secure area in their home, ensuring that discussions are confidential and cannot be overheard by others. Employees' work space must be private and without any distractions.

Position Scope:

• Uses primarily telephonic interactions/digital technology to promote the improvement of health outcomes to customers and assist those experiencing the burdens of illness and injury, through the case management process


• Assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs within their case load


• Promotes quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and consumerism approach through education and health advocacy to our customers


• Works independently and effectively communicates to internal and external customers in a virtual, telephonic environment


• Manages/coordinates an active caseload of telephonic/digital case management cases


• Establishes customer-centric SMART goals and interventions to meet the customer's needs and drive outcomes


• Builds solid working relationships with internal team members, internal and external partners, customers and providers

Major responsibilities and desired results:

• Provides 1:1 telephonic/digital case management to customers including but not limited to: reducing health risks, readmissions, assessing social determinates of health, building health literacy, ensuring customers services are appropriately in place, cost savings, collaborating with health care providers in relation to treatment plans and customer needs


• Establishes a collaborative relationship with customer, family, physicians(s) and other providers to determine medical history and current status to assess the options for optimal outcomes


• Promotes consumerism through education and health advocacy


• Assesses member's health status and treatment plan and identifies any gaps or barriers to healthcare


• In conjunction with customer's providers, establishes a documented patient centric case management plan, identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved


• Implements, coordinates, monitors and evaluates the case management plan on an ongoing, appropriate basis


• Acts as a timely and proactive liaison between account, client/family physician(s) and facilities/agencies


• Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection


• Drives efficiency and outcomes (including but not limited to engagement, retention, avoided readmissions, goal progress/achievement, cost savings) through pre post process including queue management, call and assessment process


• Based on experience, may provide leadership, preceptor/mentorship, support and coverage to other case management staff and assist case managers in achieving positive outcomes and savings


• Complies with all accreditation, State and Federal mandates.


• Completes training as required per role and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate


• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate


• Performs other related duties incidental to the work described herein

Minimum requirements :

• Active unrestricted Registered Nurse (RN) license required in State of Residence


• Three years full-time equivalent of direct clinical care and acute care required as an RN - not including clinical rotation


• Eligibility to obtain additional state licensure based on business need and required by Cigna. Must be able to obtain a California RN licensure for this role


• Access to self-provided high-speed broadband wired internet with a modem/router. Cannot support satellite-based internet or hot spots


• Excellent communication skills including telephonic (verbal) and digital (messaging, emails)


• Excellent time management, organizational, research, analytical, interpersonal skills.


• Case Management Certification preferred

Preferred requirements:

Diverse Clinical experience preferred

Bachelor's degree preferred

Experience with direct customer communication (written and oral)

Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research as well as toggle between systems, ability to talk and type effectively in real time.

Bilingual in English/Spanish a plus

Cultural Beliefs:

The candidate will be responsible for the adoption and demonstration of the Care Coordination cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

• Customer Strong: I deliver a world class experience for all customers


• Me to We: I take accountability to trust, collaborate and partner


• Be Bold: I pioneer and think broadly to solve challenges


• Own It: I see a need and act because I can


• Evolve and Adapt: I learn and adapt to meet evolving business needs


• Take Care: I prioritize self-care and act with compassion towards colleagues

Aligned Competencies:

Customer Focus - Building strong customer relationships and delivering customer-centric solutions

Drives Engagement - Creating a climate where people are motivated to do their best to help the organization achieve its objectives

Interpersonal Savvy - Relating openly and comfortably with diverse groups of people.

Manages Complexity - Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.

Nimble Learning - Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.

Manages Ambiguity - Operating effectively, even when things are not certain or the way forward is not clear.

Drives Results - Consistently achieving results, even under tough circumstances

Resourcefulness - Securing and deploying resources effectively and efficiently

Communicates Effectively - Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.

Decision Quality - Making good and timely decisions that keep the organization moving forward

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 68,000 - 113,300 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 .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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.

Cigna 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.