The RN serves as the key contact point for the patient to coordinate and streamline all services offered within Evernorth. The RN will educate the patient on healthcare options, provide patient education and answer questions as they arise. The RN will be compassionate and positive who inspires confidences in the patients they work with. The RN will work hand in hand with patients, other staff and providers to help answer any questions they have regarding schedules, appointments, orders, consults, etc. The RN will be responsible for knowing where to look for all of the members information and directing and delegating tasks to team members as needed.Key ResponsibilitiesCore Responsibilities
Be the point of contact for all aspects of the member in regard to their appointments, care, and overall health.
Act as the liaison between the providers and their patient panel, directing and delegating tasks to team members
Educate patients about their care options and make specific recommendations based on their goals
Review paperwork for patients to ensure it meets all requirements
Explain test results, diagnoses and other medical outcomes
Cover triage and transition of care for patients
Health Literacy Improvement
Improves health literacy and coaches patients on chronic conditions including disease process and trajectory, medication education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or caregiver.
Identifies problems or gaps in care and offers opportunity for intervention
Coordinates services and referrals to health programs and participates in patient education and outreach tied to HEDIS initiatives
Works to improve access to care and works as part of the team to manage heath care cost and utilization
Provider Support
Completes telephonic nursing assessments including social determinants of health screenings, post hospital discharge screenings, triage, and other assessments assigned by provider
Assists with organizing and running a chronic care and/or interdisciplinary care team rounds where high risk patients and care plans are identified
Participate using a team approach to create a care plan for the patient
Maintain and update spreadsheets and documents provided by health plan to prep weekly rounds of documentation
Post-Acute Management and Coordination
Participation in weekly care coordination with health plan case management as directed by market needs
Referral Management Care Coordination and tracking of hospice consults within 24 hrs. of order placement
Diagnostics and Lab Result Management
Obtain Pre Authorization for all CT, MRI, Echo’s ordered by providers and schedule patient
Serves as a guide in their assigned market for all escalated orders and results as clinically appropriate
Additional Responsibilities:Nursing Triage
Assess and triage immediate health concerns transferred to nursing team by clinical support staff.
Provide telephonic nursing assessment and triage supported by triage protocols. This includes, timely and accurate triage documentation, escalation, and follow up
Initiate medication changes and other orders, as directed by provider in response to a triage call.
Transition of Care
Monitors daily discharge list and develops a plan to schedule transition of care visits within the allotted timeframe
Complete telephonic post-discharge hospital visits and ask pertinent discharge triage questions and complete medication reconciliation
Document all findings and make appropriate referrals to social work, pharmacy, case management and engagement
Other telephonic patient care and provider support duties as assignedCompetencies: Communicates Effectively – Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences Manages Ambiguity- Operating effectively, even when things are not certain or the way forward is not clear Courage – Stepping up to address difficult issues, saying what needs to be said Manages Complexity – Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems Demonstrates Self-Awareness- using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses Situational Adaptability- Adapting approach and demeanor in real time to match the shift in demands of different situations Collaborates – Building partnerships and working collaboratively with others to meet shared objectivesMinimum Qualifications1) Active, unrestricted RN license in all states we provide services2) Ability to obtain compact license and/or additional state licensure as needed3) 3+ years of experience as a Registered Nurse with experience in internal medicine or adult medicine4) Proficient level of experience with Microsoft Office applications, and strong technical aptitude5) EMR experience and proficiency6) BSN or ADN degreePreferred Qualifications1) Previous experience working with the geriatric population/ chronic condition experience2) Home Health experience3) Triage experience4) Case management experience5) Previous customer service experience6) Previous experience in a telephonic role7) Highly organized, self-directed worker with an ability to function in high volume environment8) Strong verbal and written communication skills9) Prior clinical experience in palliative care, end of life, hospice, oncology, ICU, geriatrics , skilled nursing facilities, home health, skilled nursing visits is preferred.10) Knowledge of STARS and HEDIS metrics a plusIf 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.About The Cigna GroupDoing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.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.If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
