- Identifies and refers appropriate customers to eligible health and wellness programs.
- Supports Care Coordination of the individual customer. Coordinates the care of the high-risk targeted population in an appropriate, efficient, high quality and cost-effective manner. Refers to appropriate clinical partners (i.e. complex case management and / or Specialty Case management)
- Partners, and functions as central conduit between employer, provider and all available Evernorth programs and resources.
- Supports established process and procedures that ensures thorough review of patient level actionable data and reports used to support identification of customers for outreach and engagement.
- Assure and maintains timely, compliant, efficient documentation and information exchange to drive appropriate outreach, engagement and positive clinical outcomes with aligned population.
- Communicates clearly with all matrix partners, and refers to appropriate internal and external programs to support outcomes.
- Identifies cases appropriate for complex case management and follows process for referral.
- Works effectively with Evernorth's internal team to support coordination of care and data analysis.
- Identifies and builds effective relationships with local network providers. Provides steerage to high quality network providers and referrals to the onsite health center.
- Identifies gaps in care and works with providers and/ or local community resources to close gaps in care.
- Establishes and maintains a positive, professional, and collaborative relationship with customer/employee, employer, providers of care, and Evernorth partners to support improved outcomes (clinical, quality and cost) of aligned employee population.
- Partners and coordinates with health management matrix partners for additional engagement and promotion opportunities
- Acts as resource to direct customers with specific non-clinical questions to the appropriate resource.
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UnitedHealth Group Inc. Orlando, FL, United StatesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel ...
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AdventHealth Orlando, United States Paid WorkAll the benefits and perks you need for you and your family: · Paid Days Off from Day One · Career Development · Whole Person Wellbeing Resources · Pet Insurance* · Our promise to you: · Joining AdventHealth is about being part of something bigger. It's about belonging to a c ...
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RN Care Coordinator - Orlando, United States - The Cigna Group
Description
The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
RN Care Coordinator – Evernorth - Orlando FL
What we expect from you:
• RN with current unrestricted state licensure in FL
• Must have three or more years of clinical practice experience as an RN
• Care Coordination is required
• Case Management experience is preferred
• Excellent interpersonal skills. Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly.
• Experience working with high-risk patients preferred.
• Experience in project development and working in a matrix environment preferred.
• Self-directness and the ability succeed in an independent role.
• Current BLS/CPR/AED Certification
• Passion for assisting member with health improvement and navigation of the Health Care System.
• Must have strong problem solving skills
Bonus points for:
• CHES
• Health Coaching experience including chronic disease management
• High energy level, with dynamic presentation skills is required.
• Positive role model in demonstrating healthy behaviors
This role will be based onsite in Orlando, FL.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
