Nurse Case Manager Specialist - Evernorth - Northwest Georgia

Evernorth Workplace Care offers health care delivery services along with population health and health coaching solutions, conducted in person.

Our mission is to deliver proactive, personalized, and holistic patient care and coaching by acting on health data and insights to improve the overall health and wellness of our clients' employees, and those they care about most, by providing access to high quality, affordable services where they work and live.

Our Evernorth Workplace Care solution isn't a one-size-fits-all model.

Using data-driven insights, we'll customize a solution that addresses your organization's most pressing needs-creating a more affordable, predictable, and simple health care experience.

Evernorth Workplace Care - Personalized Care Where You Are

• Provide advanced professional input to complex Nurse Case Management assignments/projects.

• Plan, implement, and evaluate appropriate health care services in conjunction with the physician treatment plan.

• Handle more complex, high acuity cases, and/or account sensitive cases involving largest reserves.

• Utilize clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members.

• Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.

• Manage own caseload and coordinate all assigned cases.

• Utilize in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.


* 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 document into a medical management system.


* Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.


* Empowers customers with skills to enhance interaction with their providers.


* Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.


* Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer's provider and other Cigna Medical Management programs to provide whole-person health support.


* Tracks daily activities to trend volume and outcomes.


* Follows standard operating procedures.


* Toggles between multiple systems and applications.


* Research relevant topics in health promotion and disease prevention, as required for specific customers.


* Prioritizes work to meet commitments aligned with organizational goals.


* Understands and adheres to Case Management performance measures to d...