Supports established processes and procedures that ensure 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
Act as resource to direct customers with specific non-clinical questions to the appropriate resource.
Expected Qualifications to best serve your patients
RN with current unrestricted state licensure in Texas and ability to maintain
Multistate licensure is preferred.
Must have three or more years of clinical practice experience
Case Management experience is preferred
A high energy level with excellent oral and written communication skills.
Excellent Computer skills [MS Office including Outlook, Word and Excel]
Excellent interpersonal skills.
Must be able to work in a team environment
Flexibility and enthusiasm in learning new information and developing new skills quickly.
Demonstrate commitment to ongoing education preferred.
Comfortable communicating with multiple clinical partners
Experience working with high-risk patients preferred.
Experience in project development and working in a matrix environment preferred.
Self-directness and the ability to succeed in an independent role.
Current BLS/CPR/AED Certification
Passion for assisting members with health improvement and navigation of the Health Care System.
Must have strong problem-solving skills
Bonus points for
CHES or NBHWC
Health Coaching experience including chronic disease management
High energy level, with dynamic presentation skills is required.
Positive role model in demonstrating healthy behaviors
This position will be based in downtown Houston TX.
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 Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
