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.