Nurse Case Manager- on site (Aga Kahn) at Cigna

Job Summary

The “On site” Nurse Case Manager will assess, plan, implement, coordinate, monitor, and evaluate options and services to meet an individual’s health needs. This is also a client-facing role that involves providing clinical information regarding care programs or process, identifying collaboration options with Cigna’s preferred providers in the area, and coordinating complex care plans. The “On-site” Nurse Case Manager will also act as a provider relations facilitator, ensuring quality, cost-effective outcomes by managing care needs through education and health advocacy for members serviced. Additionally, this role includes a potential reporting line for nurses in the region.

Responsibilities

• Coordinate the delivery of medical care for members, including communicating with healthcare providers, negotiating treatment plans, and ensuring that clients receive appropriate care.
• Conduct comprehensive assessments of members' medical conditions and develop tailored care plans to ensure timely and effective treatment.
• Monitor members' progress, adjust care plans as needed, and communicate updates to members, healthcare providers, and the care team.
• Facilitate communication and coordination between members, healthcare providers, and clients to optimize care delivery.
• Manage medical costs and negotiate cost-effective treatment options with healthcare providers.
• Ensure that members receive the appropriate level of care in accordance with client policies and procedures.
• Maintain up-to-date knowledge of medical trends and advancements, applying this knowledge to the development of member care plans.
• Provide members and their families with emotional support and information about their conditions and treatment options.
• Act as a liaison and facilitator for provider relations, fostering strong working relationships with healthcare providers. This may include provider visits in the area
• Serve as the Clinical representative in the region for strategic clients ensuring their needs and expectations are met while maintaining a strong relationship with clients and scheduling visits and meetings on a regular basis.

Requirements

• Active nursing license in good standing.
• Bachelor’s degree in nursing; master’s degree preferred.
• Minimum of 5 years of experience in nursing
• Demonstrated knowledge of medical terminology and medical conditions.
• Excellent communication and interpersonal skills.
• Experience on client facing roles
• Proficiency in English (read, write, and speak fluently); additional languages desirable
• Ability to work independently and as part of a team.
• Ability to handle confidential and sensitive information with discretion.