Nurse Case Manager - Portuguese or French Required

Major Responsibilities

• Manages an active caseload of case management cases for Cigna and provides one on one case management to customers to improve health status, reduce health risks and improve quality of life.
• Uses clinical knowledge and Cigna approved guidelines and tools to assess diagnosis and treatment plans and goals and identifies gaps in care or risks for readmission or complications.
• 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.
• Delivers clinical programs including case management, chronic condition management, hospital support program, etc.
• 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
• 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
• 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
• Other duties as assigned

Requirements

• Bachelor’s in nursing, 3-5 years of experience in international clinical management
• Experience in the Africa region & International market
• Fluent in English along with either Portuguese or French required
• 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
• Flexible to work on shifts/varying work schedules.