Case Manager

2 days ago

Singapur, Singapore The Cigna Group Full time

Job Summary:

Cigna Healthcare, a division of The Cigna Group, is seeking a skilled Case Manager to join our team. As a Case Manager, you will play a critical role in guiding our customers through the healthcare system, empowering them with the information and insight they need to make informed decisions about their health and wellbeing.

Key Responsibilities:

  • Assess proposed treatment and therapies for medical necessity, appropriateness, and cost-effectiveness in accordance with relevant guidelines.
  • Source and articulate relevant guidelines while managing complex cases.
  • Complete day-to-day Case Management tasks without immediate supervision, with access to advice from more experienced team members.
  • Use clinical knowledge to assess diagnosis and treatment plans and goals, identifying gaps in care or risks for readmission or complications.
  • Establish patient-centric goals and interventions to meet the member's needs.
  • Coordinate care and interface with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
  • Develop a documented patient-centric case management plan involving all appropriate parties, identifying anticipated case results/outcomes, criteria for case closure, and promoting communication within all parties involved.
  • Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans.
  • Maintain accurate workflow and process documents.
  • Adhere to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
  • Participate in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
  • Participate in clinical projects to enhance our customer's health and wellbeing.
  • Play an active role towards Cigna's digital transformation.
  • Serve as clinical liaison to Clients.
  • Balance business needs with patient advocacy.

Requirements:

  • Bachelor's degree in Nursing.
  • Clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
  • Knowledge and experience in relevant Health Insurance fields is preferred.
  • Necessary licenses and certifications for quality assurance standards and all case management policy and procedures.

About The Cigna Group:

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.

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