RN Nurse Clinician Nashville,TN (HealthSpring)
Location: Nashville Tennessee
Description: Cigna is at the momment seeking for RN Nurse Clinician Nashville,TN (HealthSpring) right now, this occupation will be placed in Tennessee. More details about this occupation opportunity please give attention to these descriptions. Job Description
Provides clinical leadership and expertise in a specialty area in providing direct care to patients, teaching in a v! ariety of healthcare settings, and working as a researcher, consultant, or nurse manager. Requires a current RN license. .
Identifies and refers appropriate customers to eligible programs within HealthSpring, such as the Respiratory program, short or long term Case Management and newly developed Diabetes Program.
Performs office duties as assigned by PCP. Uses standing orders if appropriate and available.
Assesses member needs for medical, surgical, and behavioral health diagnosis/referral for short or long term care management; working the case in open status for the life of the case to support prospective, customer-centric care facilitation through better education and advocacy. This is facilitated by completing a thorough assessment form during the patient’s first visit to the HON nurse.
Supports care coordination and short term case management needs of the population.
Coordinates the care of the high-risk population in an a! ppropriate, efficient and cost-effective manner. Refers to app! ropriate clinical partners (i.e. Specialty such as Oncology)
Partners, and functions as central conduit between employer, provider (PCP, Onsite Nurse) and all available HealthSpring programs and resources.
Supports established processes and procedures that ensure thorough review of patient level actionable reports used to support identification of patients for outreach and engagement.
Assure and maintains timely, compliant, efficient documentation and information exchange to drive appropriate outreach, engagement and positive clinical outcomes with identified population.
Evaluates the effectiveness, necessity, and efficiency of the care plan and communicates with matrix partners to support care plan goals. Goals are established by using the initial assessment and updating as condition changes warrant. Revisions will also be based on observed response to treatment and intervention.
Educates self on the critical elements associated! with the target population such as disease states, diagnoses (ICD9) codes, utilization patterns, clinical treatment guidelines, financial processes, regulations, data resource quality and availability.
Reviews reports and collaborates with clinical partners on engagement (i.e. inpatient/discharge census) to assure successful transition of care.
Communicates clearly with all matrix partners, and refers to appropriate internal and external programs to support outcomes.
Acts as the Onsite and Partnership for Quality (P4Q) clinical liaison expert for the PCP population. Coordinates with P4Q Practice Coordinator (PC) to avoid duplication of effort.
Identifies cases appropriate for complex case management and follows process for referral. Meets with transition of care team as needed.
Works effectively with Onsite/Telephonic nurses, and Case Managers to support coordination of care.
Identifies and builds effective relationship! s with a network of community, government and knowledge resources.
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Establishes and maintains a positive, professional, and collaborative relationship with PCP, office staff, providers of care, and HealthSpring partners to support improved outcomes (clinical, quality and cost) of PCP population.
Partners and coordinates with health management matrix partners for additional engagement and promotion opportunities (i.e. poly pharmacy and/or behavioral, etc.)
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Requirements
RN with current unrestricted state licensure required.
Three to five years clinical practice experience and 2 years case management experience.
Excellent oral and written communication skills,
Computer skills [specific software e.g. Word and Excel]
Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly.
Demonstrated commitment to ongoing education preferred.
Comfortable communicating with multiple c! linical partners (direct care, Onsite Nurse, and telephonic coaching teams).
Experience working with high-risk patients preferred.
Experience in project development and working in a matrix environment preferred.
Experience in office environment and flow of patients
Good clinical skills, able to recognize patient symptoms and refer appropriately when needed.
Cool under pressure.
Able to maintain commitment to new processes while seeking ways to streamline and improve.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Mon, 29 Jul 2013 20:21:09 GMT