Registered Nurse- In Home Primary Care- Hybrid- Philadelphia, PA - The Cigna Group
Philadelphia, PA
About the Job
The RN Coordinator serves as the key contact point for the patient to coordinate and streamline all services offered within Evernorth Health Services. The patient navigator will educate the patient on healthcare options, provide patient education and answer questions as they arise. The patient navigator will be compassionate and positive who inspires confidences in the patients they work with. The patient navigator will work hand in hand with patients, other staff and providers to help answer any questions they have in regard to schedules, appointments, orders, consults, etc. The patient navigator will be responsible for knowing where to look for all of the members information and directing and delegating tasks to team members as needed.
Core Responsibilities
1. Be the point of contact for all aspects of the member in regard to their appointments, care, and overall health.
2. Act as the liaison between the providers and their patient panel, directing and delegating tasks to team members
3. Educate patients about their care options and make specific recommendations based on their goals
4. Review paperwork for patients to ensure it meets all requirements
5. Explain test results, diagnoses and other medical outcomes
6. Cover any additional triage and transition of care for patients as needed
Health Literacy Improvement
1. 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.
2. Identifies problems or gaps in care and offers opportunity for intervention
3. Coordinates services and referrals to health programs and participates in patient education and outreach tied to HEDIS initiatives
4. Works to improve access to care and works as part of the team to manage heath care cost and utilization
Provider Support
1. Completes telephonic nursing assessments including social determinants of health screenings, post hospital discharge screenings, triage, and other assessments assigned by provider
2. Assists with organizing and running a chronic care and/or interdisciplinary care team rounds where high risk patients and care plans are identified
3. Participate using a team approach to create a care plan for the patient
4. Maintain and update spreadsheets and documents provided by health plan to prep weekly rounds of documentation
Post-Acute Management and Coordination
1. Participation in weekly care coordination with health plan case management as directed by market needs
2. Referral Management Care Coordination and tracking of hospice consults within 24 hrs. of order placement
Diagnostics and Lab Result Management
1. Obtain Pre Authorization for all CT, MRI, Echo’s ordered by providers (Pt Coordinators to schedule)
2. Serves as a guide in their POD for all escalated orders and results as clinically appropriate
Additional Responsibilities
Nursing Triage
1. Assess and triage immediate health concerns transferred to nursing team by clinical support staff.
2. Provide telephonic nursing assessment and triage supported by triage protocols. This includes, timely and accurate triage documentation, escalation, and follow up
3. Initiate medication changes and other orders, as directed by provider in response to a triage call.
Transition of Care
1. Monitors daily discharge list and develops a plan to schedule transition of care visits within the allotted timeframe
2. Complete telephonic post-discharge hospital visits and ask pertinent discharge triage questions and complete medication reconciliation
3. Document all findings and make appropriate referrals to social work, pharmacy, case management and engagement
_Other telephonic patient care and provider support duties as assigned_
Competencies:
• 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 objectives
Minimum Qualifications:
1) Active, unrestricted RN license in all states we provide services
2) Ability to obtain compact license and/or additional state licensure as needed
3) 3+ years of experience as a Registered Nurse
4) Proficient level of experience with Microsoft Office applications, and strong technical aptitude
5) EMR experience and proficiency
6) BSN or ADN degree
Preferred Qualifications:
1) Previous experience working with the geriatric population/ chronic condition experience
2) Home Health experience
3) Triage experience
4) Case management experience
5) Previous customer service experience
6) Previous experience in a telephonic role
7) Highly organized, self-directed worker with an ability to function in high volume environment
8) Strong verbal and written communication skills
9) Prior clinical experience in palliative care, end of life, hospice, oncology, ICU, geriatrics is preferred.
10) Knowledge of STARS and Hedis metrics a plus
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.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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._
_Qualified applicants with criminal histories will be considered for employment in a manner_
_consistent with all federal, state and local ordinances._
_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._
Core Responsibilities
1. Be the point of contact for all aspects of the member in regard to their appointments, care, and overall health.
2. Act as the liaison between the providers and their patient panel, directing and delegating tasks to team members
3. Educate patients about their care options and make specific recommendations based on their goals
4. Review paperwork for patients to ensure it meets all requirements
5. Explain test results, diagnoses and other medical outcomes
6. Cover any additional triage and transition of care for patients as needed
Health Literacy Improvement
1. 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.
2. Identifies problems or gaps in care and offers opportunity for intervention
3. Coordinates services and referrals to health programs and participates in patient education and outreach tied to HEDIS initiatives
4. Works to improve access to care and works as part of the team to manage heath care cost and utilization
Provider Support
1. Completes telephonic nursing assessments including social determinants of health screenings, post hospital discharge screenings, triage, and other assessments assigned by provider
2. Assists with organizing and running a chronic care and/or interdisciplinary care team rounds where high risk patients and care plans are identified
3. Participate using a team approach to create a care plan for the patient
4. Maintain and update spreadsheets and documents provided by health plan to prep weekly rounds of documentation
Post-Acute Management and Coordination
1. Participation in weekly care coordination with health plan case management as directed by market needs
2. Referral Management Care Coordination and tracking of hospice consults within 24 hrs. of order placement
Diagnostics and Lab Result Management
1. Obtain Pre Authorization for all CT, MRI, Echo’s ordered by providers (Pt Coordinators to schedule)
2. Serves as a guide in their POD for all escalated orders and results as clinically appropriate
Additional Responsibilities
Nursing Triage
1. Assess and triage immediate health concerns transferred to nursing team by clinical support staff.
2. Provide telephonic nursing assessment and triage supported by triage protocols. This includes, timely and accurate triage documentation, escalation, and follow up
3. Initiate medication changes and other orders, as directed by provider in response to a triage call.
Transition of Care
1. Monitors daily discharge list and develops a plan to schedule transition of care visits within the allotted timeframe
2. Complete telephonic post-discharge hospital visits and ask pertinent discharge triage questions and complete medication reconciliation
3. Document all findings and make appropriate referrals to social work, pharmacy, case management and engagement
_Other telephonic patient care and provider support duties as assigned_
Competencies:
• 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 objectives
Minimum Qualifications:
1) Active, unrestricted RN license in all states we provide services
2) Ability to obtain compact license and/or additional state licensure as needed
3) 3+ years of experience as a Registered Nurse
4) Proficient level of experience with Microsoft Office applications, and strong technical aptitude
5) EMR experience and proficiency
6) BSN or ADN degree
Preferred Qualifications:
1) Previous experience working with the geriatric population/ chronic condition experience
2) Home Health experience
3) Triage experience
4) Case management experience
5) Previous customer service experience
6) Previous experience in a telephonic role
7) Highly organized, self-directed worker with an ability to function in high volume environment
8) Strong verbal and written communication skills
9) Prior clinical experience in palliative care, end of life, hospice, oncology, ICU, geriatrics is preferred.
10) Knowledge of STARS and Hedis metrics a plus
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.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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._
_Qualified applicants with criminal histories will be considered for employment in a manner_
_consistent with all federal, state and local ordinances._
_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._
Source : The Cigna Group
