(RN) Spanish Speaking Complex Nurse Case Manager (Work At Home)
Location: Montgomery Alabama
Description: Cigna is presently looking of (RN) Spanish Speaking Complex Nurse Case Manager (Work At Home) right now, this career will be placed in Alabama. For detail informations about this career opportunity please read the description below. Job Description
NOTE: Must be fluent in Spanish and English
Major Duties:
This position! , the Complex Nurse Case Manager through the case management process, will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population based on business perspectives. The Case Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced. Ability to work independently and effectively communicate to internal and external customers in a telephonic environment. The CAC aligned Case Manager has enhanced collaboration with Physician Group Embedded Care Coordinators (ECC).
Major responsibilities and desired results:
Establ! ishes a collaborative relationship with client (plan participa! nt/member), family, physician(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
Promote consumerism through education and health advocacy.
Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. 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.
Implements, coordinates, monitor and evaluates the case management plan on an ongoing, appropriate basis.
Negotiates price, level of care, intensity and duration with provider(s), as appropriate.
Acts as a timely and proactive liaison between account, client/family, physician(s) and facilities/agencies
Maintains accurate record (system) of case m! anagement interventions including cost/benefit analysis, savings, and data collection.
Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
Compliant with all accreditation, State and Federal mandates
Delivers utilization review services when member is in active case management as appropriate
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.
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
Engage our CAC partner (Embedded Care Coordinator) to support service to our customers.
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Requirements
Qualifications:
MUST be flue! nt in Spanish and English
RN License required- must be active in the state of residence
Clinical experience in acute care, or a clinical setting, or case management including experience/expertise in one of the following selected fields of nursing: Intensive Care / Obstetrics/ Cancer Care / Rehabilitation / Coronary Care / Neurology / Trauma / Neonatology / Respiratory Care / Transplant Dialysis / Medical-Surgical/ Home Health / Hospice/Pediatrics
Within four (4) years of hire as a case manager, the case manager will possess a URAC-recognized certification in case management.
Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
Knowledge of the insurance industry and claims processing
Service marketing/sales and business acumen experi! ence a plus
Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
Experience in medical management and case management in a managed care setting is highly desirable
Knowledge of managed care products and strategies
Demonstrated sensitivity to culturally diverse situations, participants and customers
Ability to work within changing business environment and balance business needs with patient advocacy
Experience managing multiple projects in a fast paced matrix driven environment
Demonstrated ability to coach and educate other case management staff Demonstrate effective organizational skills and flexibility to meet the business needs
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Fri, 04 Oct 2013 20:17:17 GMT
Apply (RN) Spanish Speaking Complex Nurse Case Manager (Work At Home) Here