Complex Nurse Case Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with clients to evaluate their needs, create personalized care plans, and document interventions and outcomes in Cigna medical management systems.

• Work alongside clients and healthcare providers to set goals, implement interventions, and develop evidence-based care plans.

• Utilize motivational interviewing, behavior change techniques, and shared decision-making to enhance engagement and promote better health results.

• Equip clients to navigate the healthcare system and effectively communicate with their providers.

• Coordinate care among clients, caregivers, providers, and internal teams through phone and digital channels.

• Collaborate with interdisciplinary teams, which include pharmacists, nutritionists, behavioral health clinicians, Medical Directors, and Medical Management programs.

• Monitor, analyze, and document daily activities, volume, and outcomes to aid performance and quality objectives.

• Adhere to established policies, procedures, and Case Management performance metrics.

• Navigate various systems and applications in a dynamic, customer-focused environment.

• Complete mandatory training and maintain clinical expertise, licensure, and certifications.

⛳️ Requirements

• Active and unrestricted Registered Nurse (RN) license in your state of residence.

• A minimum of two (2) years of full-time direct patient care experience as an RN.

• Preferred specialty case management experience; complex experience is preferred for specialty positions.

• Ability to secure a URAC-recognized Case Management certification within four (4) years of employment.

• Strong clinical judgment to evaluate risk, prioritize care, and make informed decisions.

• Excellent verbal and written communication skills across both phone and digital platforms.

• Proficiency in Microsoft Word, Excel, Outlook, and online research tools.

• Capacity to resolve conflicts, collaborate across teams, and engage with diverse populations.

• Strong organizational skills with a high degree of adaptability.

• Comfort in managing multiple complex cases at once.

• For remote work, a cable broadband or fiber optic internet service with a minimum of 10Mbps download and 5Mbps upload speed is required.

🏝️ Benefits

• Eligibility for the annual bonus plan.

• Medical benefits.

• Vision benefits.

• Dental benefits.

• Access to well-being and behavioral health programs.

• 401(k) retirement plan.

• Company-paid life insurance.

• Tuition reimbursement.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence.