Nurse Case Manager Senior Analyst
- Madrid
- Permanente
- Tiempo completo
- Manages/coordinates an active volume of cases by providing information and coordination to customers worldwide in a multicultural 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.
- 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 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.
- Serve as clinical liaison to Clients.
- Bachelor in Nursing, 3-5 years of experience in international clinical management.
- Languages required: English and French or Portuguese or Arabic
- 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.