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Posted: Sunday, February 4, 2018 4:58 AM

Description: //(RN//) Localization Coordinator//- Complex Case Manager//- Mid AtlanticNOTE: Candidates must reside in the mid//-Atlantic region//.The role of Localization Coordinator has been developed as a clinical service model to support Cigna's strategy of collaborating with participating providers to achieve the triple aim of improved quality of health, increased affordability thru decreases in total medical costs and a positive customer and Health Care Professional experience//.The overall goal of the role is to coordinate the delivery of health care services available to Cigna customers through a systematic process of customer identification, case review and collaboration for IFP customers not aligned to a CAC in the assigned market//.Collaboration begins with developing positive working relationships with participating providers//. We believe that sharing customer specific actionable information where the action is easy and the value is clear, will result in positive outcomes//.Major Job Responsibilities and Required ResultsActively engages with health care professionals //(HCP//) and their staff to share actionable information on active patients//.Assists the HCP and their staff and the customer to deliver coordination of care actions associated with the triple AIM//. These actions may include and are not limited to: post//-acute transition of care including outreach to the customer when customer not engaged with a CM post ER transition of careER reduction and clinically appropriate alternative benefit optimization //(pharmacy//)complex case consultation population mgmt//. activities associated with risk reduction care coordination across multiple providersCoordinates referrals for unattached customers in the locality to physicians participating in a designated service area//.Assists with identification of and referral to Cigna programs and products in collaboration with the treating HCP//.Assures clear communication among the health care team and Cigna through facilitating live conversation and documentation in Cigna//.Works effectively with Cigna Clinical staff to coordinate care coordination with HCP when needed//.Establish and maintain a professional, collaborative positive relationship with the patient, family, physician//(s//), and other providers to assess the options for care and use of benefits and community resources through appropriate outreach//.Maintains appropriate documentation and tracking as required//. Act as liaison between the defined Medical Group and Health Facilitation Center regarding specialty Prior Authorization requests, as needed//.Educate matrix partners about health management programs available to customers via Cigna or via the HCP / delivery team//.Works synergistically with Network Operations team to drive physician behavior yielding improved outcomes for the customer and potential cost savings to the Health Plan//. Qualifications: Minimum RequirementsActive unrestricted Registered Nurse //(RN//) license in state or territory of the United StatesMinimum of three years full//-time direct clinical care to the consumerTravel within the region requiredPreferred RequirementsClinical experience in acute care or case management preferred//.One to three years experience in a Managed Care environmentExcellent time management, organizational, research, analytical, negotiation, communication //(verbal and written//) and interpersonal skills f or optimal efficiency and effectiveness//.Ability to work in multiple online systems including external Electronic Medical Records //(EMR s//),Computer skills and typing expertiseURAC//-recognized certification in case management within four //(4//) years of hire Primary Location: Virginia//-Virginia Other Locations: United States//-District of Columbia//-Washington, United States//-Pennsylvania, United States//-Maryland, United States//-New Jersey, United States//-District of Columbia, United States//-New York, United States//-Work From Home Jobs, United States//-Delaware, United States//-West Virginia Work Locations: Job: Med Mgt//-//-Case Management Schedule: Regular Shift: Standard Employee Status: Individual Contributor Job Type: Full//-time Job Level: Day Job Travel: Yes, 50 % of the Time Job Posting: Jan 30, 2018, 9:25:07 AM Associated topics: asn, care, care unit, domiciliary, intensive, neonatal, nurse, surgery, transitional, unit
Associated topics: asn, care, care unit, ccu, maternal, mhb, nurse, psychatric, recovery, surgery


• Location: New Jersey

• Post ID: 158166142 nynj is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018