Cigna Nurse Case Manager Jobs in Kenya

Cigna Nurse Case Manager Jobs in Kenya

Cigna is one of the world’s leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific.

Cigna Global Health Benefits (CGHB) is an integral part of Cigna's growing international businesses. Product types include Medical, Dental, Vision, Life, AD&D, Disability, Travel, etc. sold to groups and individuals. We have approximately 1 million medical members around the world.

Major Responsibilities

Manages an active caseload of case management cases for Cigna and provides one on one case management to customers to improve health status, reduce health risks and improve quality of life.

Uses clinical knowledge and Cigna approved guidelines and tools to assess diagnosis and treatment plans and goals and identifies gaps in care or risks for readmission or complications.

Works with a multicultural population and is constantly aware of the cultural differences among that population.

Establishes patient centric goals and interventions to meet the member’s needs

Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.

Delivers clinical programs including case management, chronic condition management, hospital support program, etc.

Balances business needs with patient advocacy

Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.

Visit providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.

Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.

Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans

Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching,

pre assignment assessment and any other program delivered by global clinical operations.

Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations

Maintains accurate workflow and process documents

Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures

Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

Demonstrates sensitivity to culturally diverse situations, clients and customers.

Serve as clinical liaison to Clients

Other duties as assigned

Requirements

Bachelor’s in nursing, 3-5 years of experience in international clinical management

Experience in the Africa region & International market

Fluent in English along with either French, Portuguese or Spanish, any other language is a plus

Demonstrated organizational and leadership skills

Strong interpersonal and communication skills

Demonstrates problem-solving and analytical skills.

Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements

Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.

Experience with clinical guidelines solutions such as coverage policy and MCG guidelines

Ability to build solid working relationships with staff, matrix partners, customers and providers

Flexible to work on shifts/varying work schedules.

How to Apply

For more information and job application details, see; Cigna Nurse Case Manager Jobs in Kenya

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