Summary
Date Posted: Wednesday, March 01, 2023 , Base Salary: Not Disclosed

JOB DETAILS:
Major responsibilities and desired results:
Uses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
• Wil work across IO, GEH and GIH segments
• Manages/coordinates an active volume of cases by providing information, navigation and coordination to customers worldwide.
• Works with a multicultural population and is constantly aware of the cultural differences among that population.
• Establishes patient centric goals and interventions to meet the member’s needs
• Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
• Balances business needs with patient advocacy
• Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
• Visit providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
• Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
• Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
• Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.
• Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations
• Maintains accurate workflow and process documents
• Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Demonstrates sensitivity to culturally diverse situations, clients and customers.
• Serve as clinical liaison to Clients
• Other duties as assigned

Minimum requirements:
• Bachelor in Nursing, 3-5 years of clinical experience ideally, in international clinical management
• Demonstrated organizational and leadership skills
• Strong interpersonal and communication skills
• Demonstrates problem-solving and analytical skills.
• Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
• Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
• Ability to build solid working relationships with staff, matrix partners, customers and providers

Language requirements:
• English, French & Arabic: read, write and speak fluently

Work Hours: 8

Experience in Months: 60

Level of Education: Bachelor Degree

Job application procedure

Use the link(s) below to apply on company website.
Nurse Case Manager

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