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Cigna
,
Greenock, Renfrewshire
Mental Health Nurse Case Manager
Overview
Job Description
This is a key role which contributes to the operational effectiveness of our UKHB business. The primary role of the Mental Health Case Manager is to administer and maintain Cigna's Mental Health Programme on a day to day basis. The Case Manager will support the ongoing development of Cigna's Mental Health programme. This ensures it maintains the highest standards of case management and utilisation review, and the programme remains at the forefront of Mental Health and care management developments. You will have sound knowledge and the ability to assess patient treatment plans and act on the need for alternative services. The role will involve providing quality and cost effective care in every instance. You will have an active involvement and focus through owning and driving sustained performance. This will involve liaising with your patients, our clients and providers to ensure their enquiries, either medical or administrative are managed within a caring, supportive and business driven environment. **Case Management** You will work to coordinate individualised care for your patients. Ensure proper utilization of services and resources. You will work with your patients, families and other professionals to make provision for their current and future needs. You will also promote quality care which encourages appropriate use of available resources. Case managers ensure that ethical and legal issues are addressed. They also ensure that patients receive medically appropriate services. They need to be experts regarding public and private insurance reimbursement policies regarding healthcare. Case managers review charts and meet with other health care professionals to ensure that patients receive appropriate levels of care. They facilitate admission and discharge processes. This will be carried out in line with Cigna's inpatient criteria and individual company requirements **Main Duties / Responsibilities** + Perform a telephonic role + Maintain accurate records and files as required + Work with patients to problem solve + Assess the possibility of offering flexible benefits to the patient + Educate and advise patients about how to prevent and/or improve conditions + Use internal support tools to provide health advice to members + Provide accurate policy coverage advice + Achieve / exceed set productivity and quality standards + Communicate regularly with patients, Nurses, scheme administrators, consultant's, Customer Service Agents etc...regarding treatment plans and claims costs + Interface effectively with internal staff and external providers to resolve customer issues + Actively support other team members in the achievement of team objectives + Identify potential process improvements and make recommendations to your direct Manager + Keep up to date with new treatments available for treating patients + Participate in and contribute to in-service education for our external clients + Participate in and support ongoing healthcare services product development **Skills** Good time management skills Organisational awareness Research skills Negotiation Skills Good communication skills Good interpersonal skills Excellent Customer Service Skills Ability to work within service level agreements Business & Customer Focus Initiative & Ownership **Experience Required** Minimum of 4 years clinical experience in acute psychiatry, alcohol/drug addictions, eating disorders. You must be + Registered with the Nursing & Midwifery Council (NMC) + Be able to evidence you are continually working to meet the requirements of revalidation **About Cigna** Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.