Maternity Nurse Case Manager

2d2 days ago

The Cigna Group

Pittsburgh, US · Full-time · $70,000 – $95,000

About this role

Case managers are healthcare professionals who serve as customer advocates to coordinate, support, and guide care for customers, families, and caregivers navigating the healthcare journey. They adopt and demonstrate Care Solutions cultural beliefs, role modeling six beliefs like Customer Strong and Own It to drive accountability and results.

In daily responsibilities, collaborate with customers to create and document care plans in medical management systems. Partner to establish goals and interventions using motivational interviewing, behavior change, and shared decision making for optimal health.

Interface with customers, families, providers, nutritionists, pharmacists, behavioral clinicians, Medical Directors, and internal partners via telephonic, email, text, and chat interactions. Provide whole-person health support while tracking activities, following procedures, and toggling between systems.

Prioritize work to meet organizational goals, adhere to performance measures, and complete required training. Demonstrate continuing education to maintain clinical expertise and certification, adapting to evolving business needs in a fast-paced environment.

Requirements

Active unrestricted Registered Nurse (RN) license in state or territory of the United States
Minimum of two years full-time direct patient care as an RN required
Experience in the specialty (Maternity) preferred
Must have an active and unencumbered RN License
Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management
Excellent communication skills including telephonic (verbal) and digital (messaging, emails)
Strong computer skills in Microsoft Word, Excel, Outlook, and ability to perform thorough internet research
Skilled in clinical acumen to form a judgement and act

Responsibilities

Collaborates with customer in creation of care plan and documents plan in medical management system
Partners with each customer to establish goals and interventions to meet the customer’s needs
Establishes plan of care in conjunction with the customer and provider then documents into a medical management system
Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health
Empowers customers with skills to enhance interaction with their providers
Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate needs
Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer's provider
Tracks daily activities to trend volume and outcomes