Position Summary :
Plans, implements, and evaluates appropriate health care services to assist the customer throughout their oncology health journey.
Utilizes clinical skills to assess, coordinate, monitor and evaluate options and services in order to facilitate appropriate health care outcomes for customers.
Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
Maintains current knowledge of Cigna Healthcare Policies and Procedures, CMS requirements, State Medicaid requirements, NCQA standards and recommendations impacting care coordination, and Special Needs Plans Model of Care program goals and requirements, as applicable.
Essential Duties and Responsibilities :
- Outreach to oncology customers for coordination of care and continuity of care management.
- Identify customer needs, coordinate and support planned and unplanned transitions, conduct post discharge follow up contact, which may include primary care physician and specialist appointment scheduling.
- Provide clinical assessments, health education, and utilization management to customers, as needed.
- Initiate contact with customer / caregiver / family, primary care physician, and health care providers / suppliers as needed.
- Develop and monitor customer’s individualized plan of care, as well as communicate the plan of care to the customer and primary care physician.
Prioritize case goals, monitor the completion of care goals and modify the individualized plan of care in the integrated care management system as needed.
- Document all encounters with the customer and practitioners and providers.
- Evaluate each case for quality of care, document and report quality issues to the appropriate team.
- Other duties as assigned.
Qualifications :
- Registered Nurse with 1-2 years related experience and / or training in Case Management
- 1-2 years of oncology nursing experience
- Medicare and / or Medicaid experience with geriatric populations
- Certified Case Manager preferred
- Experience with community resource organizations
- Experience handling confidential health care information, with care management software applications
- Experience managing customers with complex medical and behavioral health concerns preferred
Knowledge, Skills, Abilities Required :
- Excellent interpersonal and communications skills
- Strong research and analytical skills
- Strong time management and organization skills
- Basic proficiency in Word, Outlook, PowerPoint, Excel
- Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
- Ability to make decisions on what needs to be done based on clearly established guidelines
- Spanish language ability is desirable
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