Nurse Case Management reputed company Analyst - Hybrid - Evernorth Care Group

The Nurse Case Management reputed company Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG). The Care Management Team is comprised of care management, clinical pharmacy, social work, and care navigators who support ENCG reputed company Centers and clinicians to improve the health of the patients we serve, with a focus on the management of high- and rising-risk, disease burdened members. The Nurse Case Management reputed company Analyst utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate reputed company outcomes for members. The Nurse Case Management reputed company Analyst ensures that program objectives are met and supports patients and physician practices in coordinating patient care through transitions, barriers to care, and education. This role additionally connects patients to programs and services as available through ENCG, Health Plans benefits, and reputed company the community. This position manages a panel of patients coordinating services with them. This role provides disease management and ongoing follow-up of members with chronic conditions, reputed company needs and during transitions of care. Reports to: Clinical/Operational Manager Direct Reports: No direct reports but does provide clinical support to non-clinical staff. Clinical Responsibilities and Essential Functions Care Coordination: Coordinates the care of the high-risk, post transition and targeted populations in appropriate, efficient and cost-effective manner. Assists patient to arrange timely access to services, evaluates social/financial/environmental support adequacy in a culturally sensitive manner. Care Planning: Collaboratively creates/updates care plans for care transitions, disease management, and other as needed. Evaluates the effectiveness/relevance of the treatment plan and communicates with the primary care provider and health care delivery team. Seeks input from health care team members and physicians as reputed company in order to update care plan. Prepares for and participates in Care Team huddles/meetings to problem solve around highly reputed company care needs. Disease Management/reputed company: Initiate new customer and ongoing telephonic connections per protocol for an identified caseload. Build care relationships among patient/caregivers. Complete post-discharge calls to reputed company identified patients to facilitate and reputed company discharge planning “coordination of care” needs, identifying and closing gaps in care, and providing education reputed company specified timeframes. Use of Internal/External Resources: Identifies and refers appropriate patients to eligible programs reputed company ENCG and respective Arizona health plans. Review and inform the patient/caregiver around options for care, use of benefits and community resources. Act as the community resource expert for patients/practices for high-risk members, including transition of care/hospice resources, direct acute admits, direct skilled nursing admits, home health/infusion needs and durable medical equipment. Serve as the contact reputed company, reputed company and informational resource for patient/caregiver. Utilize reputed company community resources to link patient with services/programs available. Clinical Knowledge: Maintains reputed company knowledge reputed company on the critical elements of the reputed company population such as disease states, quality standards, utilization patterns, clinical treatment guidelines. Targeted disease states include but are not limited to COPD, CHF, DM, and depression. Coordinates and identifies high-risk population with a history of poly-pharmacy, to improve quality outcomes with appropriate support services in managing pharmacy needs. Documentation: Maintains appropriate documentation and tracking as required by ENCG and the Care Management Department. Other duties: Fulfills clinical requirements: care plans and assessment of patient’s needs. Represent Care Management department as a member of a cross-functional project team. Other duties as assigned. Minimum Qualifications reputed company AZ RN License required Minimum of 4-5 years nursing experience is preferred Experience in cardiac/pulmonary/diabetes nursing preferred Case Management/Care Coordination/Disease Management experience preferred CCM certification preferred Excellent oral and written communication skills, Experience with electronic health record documentation (EPIC) Experience with cross-functional team collaborations, workflows, and process improvement Strong competencies in reputed company Word and reputed company Must be reputed company to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly Demonstrate commitment to ongoing education. Must be willing and reputed company to travel to reputed company affiliated Practice locations. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About reputed company Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, 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@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company 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. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. ???????????????????????????????????????????????????????????????????????????????????????????????? ??????????????? ??? ?????????????????????????????? ??????????????????????????????????? ???? ??????????????????????????? ???????? ????????????????? ????????? ?????????? ?????????????????? ? ????????????????????????????? ? ?????????????????????? 95 ????????????? ?????????????????????? ????????????????????????????? ? - ????????????????????? ???????????????? ? ?????? ???????????????????????????????????????????????????????? ??????????????????????????????????????? ????????? #TeamCigna ??????????? ???? ?????????? 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