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Description
Major responsibilities and desired results:
- Recruits, selects and hires qualified Case Management staff (may include referral analysts, case managers, benefit specialists, benefit analysts, and health service specialists)
- Maintains quality improvement and ongoing personal development of all staff.
- Supervises, monitors, and reviews performance of a Case Management team to assure that case management services are delivered promptly, cost effectively, courteously and according to Policy and Procedure, Case Management Standards, and Quality Assurance standards.
- Manages annual and semi-annual performance evaluation process, individual discussion and feedback, and compensation for all team members.
- Collaborates with Quality team for quality improvement opportunities and appropriate actions.
- Partners with matrix members for the development of appropriate work plans and takes corrective action when necessary to ensure that objectives, standards, policies and procedures are met
- Manages appropriate level of follow-up for all work plan and individual performances.
- Acts as liaison and problem-solver between Case Managers and matrix partners.
- Evaluates ongoing and future staff requirements/needs to meet customer, site, and corporate objectives.
- Works with Manager to establish and ensure achievement of units customer service, utilization patterns, productivity, quality, and financial goals.
- Supports all corporate and/or national quality/certification initiatives (i.e. URAC)
- Communicates and manages staff to QA and/or productivity standards, as applicable.
- Supports Manager, Corporate, and Sales/Client Services in evaluating customer's service, utilization patterns, quality and financial results to assure that service delivery is within parameters defined by product and underwriting model.
- Acts in account management and performs active customer service function for account(s); provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instructions or procedures that must be followed by Case Management team.
- May need to support the Case Manager to gain approval from customer(s) for case management service (as required), for extra contractual service requests, recommended care plan, or other needs
- Supports needs for current and prospective customer visits, presentations and/or audits.
- Maintains clinical knowledge and provides coaching to staff, based on area of medical expertise, when requested
- Demonstrates evidence of continuing education in clinical and/or business management areas.
- Advises all staff of any pertinent changes in customer, service delivery, or business functions.
- Demonstrates leadership in sensitivity to culturally diverse situations with staff, matrix partners, clients and customers.
- Ensures that all key metrics and financial targets are achieved.
- Other duties as required and related to this role.
Qualifications
Active RN licenure
1. A bachelors (or higher) degree in a health related field .
2. Certification as a case manager preferred. (CCM)
3. Must have 3 years of clinical experience
- Demonstrated ability to assist with sales/training/account service management
- Experience in training and staff development
- Excellent communication, interpersonal, and analytical skills
- Acquired knowledge of benefit plan design and customer needs
- Excellent time management, organizational, research and negotiation skills
- Knowledge of the insurance industry and claims processing
- Service marketing/sales experience a plus
- Ability to use basic document, spreadsheet, internet, email applications, and strong computer skills
- Ability to work in a fast-pace and changing business environment
- Ability to build solid working relationships with staff, customers, or providers
- Demonstrated process improvement experience
Pay Benefits Work Schedule
CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development.
How To Apply
We encourage you to complete all questions on the candidate profile if you wish to be considered for this opportunity.
Details:
Job Id:
19152714
Posted / Updated:
3/23/2010 4:12:56 AM
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