Title: Nurse Case Management Senior Analyst - EviCore - Work at Home
Location: CT-Bloomfield
Job Description: Evernorth Nurse Case Management Senior Analyst (Home-Based TOC)
Objective: Prevention of readmission for high-risk members by leveraging telephonic and in-home visits to identify gaps in care and ensure timely interventions.
Responsibilities:
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Comprehensive health risk assessments to understand member care coordination needs, risk factors, and gaps in care following discharge. Includes medical, behavioral, SDoH, and functional dimensions.
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Medication reconciliation, adherence, and education .
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Review of discharge summary for adherence
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Disease education, including self-management and s/s to report
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MD appointment scheduling and follow-up
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Referral to Social worker to support members with socioeconomic needs including: financial, caregiver, housing, food, and other needs
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Care coordination for additional services that may be needed to support recovery, ex: DME
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Provide direct access to member for any concerns that arise during the TOC program duration
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Care summaries provided to PCPs and health plans upon conclusion of the program to support transition, including Case Management referrals for ongoing services
License Requirements:
- Current unrestricted Registered Nurse license. Must be licensed in state of residence. Multistate license preferred. May be required to obtain licensure in other states serviced.
Experience
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Minimum 5 years clinical experience with at least 3 years managed care experience.
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2 - 4 years' experience in Managed Care preferred.
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Acute, Home health, SNF, and/or rehab background experience preferred.
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Position requires telephonic and In-Home coverage.
Requirements:
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Hours: 8a-5p Central Time Zone.
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Position is full-time with potential for weekend and holiday coverage.
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Time-management: Ability to manage one's time and resources to ensure that work is completed efficiently. Excellent organizational skills.
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Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership.
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Critical thinking/Decision-making: Ability to choose a course of action or develop appropriate solutions by identifying and understanding issues, problems, and opportunities.
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Autonomy: Ability to work independently with little to no supervision.
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Proficient in computer literacy skills with ability to use Microsoft Word, Excel, Outlook, and PowerPoint. Experience using videoconferencing systems such as WebEx.
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Ability to type minimum of 30 wpm preferred.
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Ability to sit at a desk for long periods.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 68,700 - 114,500 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
