Provides advanced professional input to complex Case Management assignments/projects. Handles more complex, high acuity cases and/or account sensitive cases. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Evaluates, recommends, and maintains close relationship with inpatient and outpatient counseling/treatment facilities. Evaluates employee counseling and treatment needs and makes recommendation on changes or additions to appropriate programs. May assist with designing and conducting training and educational seminars. Manages own caseload and coordinates all assigned cases. Performs leadership role on team when implementing new tools or case management programs/initiatives. Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Case Management. May require a Master's Degree in a health care related field with current licensure. At Cigna, we listen to, advocate for, and collaborate with our customers to empower them to identify their health goals and own their solutions. Sound like you? Great! Here’s more on how you’ll make a difference:
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