JOB PURPOSE
The Nurse Case Manager will assess, plan, implement, coordinate, monitor, evaluate options and services to meet an individual’s health needs. Clinical support may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans. The Nurse Case Manager will promote quality cost-effective outcomes managing care needs through education and health advocacy to members serviced. The Nurse Case manager is able to work independently and effectively communicate to internal and external customers by telephone, email or face to face with customers.
RESPONSIBILITIES AND DUTIES
The Nurse Case Manager uses his/ her clinical knowledge to assess diagnosis, evaluate treatment plans, set clinical progress goals and identify gaps in care or risks for readmission or complications.
Manages/coordinates an active volume of cases by providing clinical support, information, navigation, and coordination to customers in KSA.
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.
Visits providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services, 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.
Works 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.
Coordinates 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.
Serves as clinical liaison to Clients.
Attends to other clinical duties as assigned.
Minimum requirements:
Bachelor in Nursing, 3-5 years of experience in international clinical management
Experience as a case manager in Saudi Arabia.
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.
Experience with clinical guidelines solutions such as coverage policy and MCG guidelines.
Ability to build solid working relationships with staff, matrix partners, customers and providers.
Language requirements:
English: read, write, and speak fluently.
Arabic is a plus.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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.
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