Case Manager

**Position Title**: Case Manager

**Job Purpose**: To assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs. Assistance may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans.

**Reports to**: Manager, Health & Clinical Services

**Critical Tasks and Expected Contributions/Results**:
Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
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.
Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
Coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
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.
Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.
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.
Participates in clinical projects to enhance our customer’s health and wellbeing.
Plays an active role towards Cigna´s digital transformation.
Serve as clinical liaison to Clients.

**Key Challenges/Anticipated Changes in Environment**:
Demonstrates sensitivity to emotionally distressed and also culturally diverse situations, clients and customers.
Manages/coordinates an active volume of cases by providing information and coordination to customers worldwide in a multicultural population.
Coordinate care with other Cigna Case Managers around the world when a need for local or regional expertise is important for better care or to comply with regulations

**Developmental Value of Position**:
Gain experiences and knowledge within the insurance and healthcare industry
Broad exposure to all aspect of business operations and to develop leadership/general management skills
Continue to utilize and enhance healthcare knowledge while out of clinical setting

**Experience/Knowledge, Education and Other Requirements**:
Bachelor in Nursing
Clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications
Necessary licenses and certifications for quality assurance standards and all case management policy and procedures

**Personal Competencies Required**:
Demonstrated strong organizational and leadership skills
Strong interpersonal and communication skills
Demonstrates problem-solving and analytical skills.
Ability to build excellent working relationships with staff, matrix partners, customers and providers
Ability to act as an “advocate” for the customer while complying with internal Policies and procedures and contractual/legal compliance requirements
Strong time management and prioritisation skills
Enthusiastic with a positive attitude
Ability to operate computer, proficient with Microsoft office products, call center software, and a variety of software.

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?