Responsible for providing support to patients, their families, and physicians in addressing medical and social concerns. Educates patients and families to make informed personal health care decisions. Facilitates communication between patient, physician, health plan, and community..
Major Duties & Responsibilities:
Under general supervision, responsible for identifying high risk patients for case management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan, and community resources.
Directs intervention with moderate to high risk members, and provides support and oversight to other team members managing low risk members.
Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan development.
Initiates contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment plan and conducts on-site or in-home evaluations as necessary.
Monitors, evaluates, extends, revises or closes treatment plans as appropriate. Evaluates cases for quality of care. Communicates case management decisions. Understands and follows policies and procedures and produces and submits reports in a timely manner.
Handles high acuity and complex cases. Serves as a professional resource to other Case Managers. Initiates and leads the multi-disciplinary care planning process.. Requirements
Current licensure as a Registered Nurse (RN) in FL
5+ years of clinical experience in acute care
Strong PC skills required
Strong communication skills
Certified Case Manager..
CIGNA - 23 months ago
copy to clipboard
With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...