The RN serves as the key contact point for the patient to coordinate and streamline all services offered within Evernorth. The RN will educate the patient on healthcare options, provide patient education and answer questions as they arise. The RN will be compassionate and positive who inspires confidences in the patients they work with. The RN will work hand in hand with patients, other staff and providers to help answer any questions they have regarding schedules, appointments, orders, consults, etc. The RN will be responsible for knowing where to look for all of the members information and directing and delegating tasks to team members as needed.

Telephonic patient care role. Primarily responsible for patient triage, care coordination, and patient/family education for members across all Evernorth Health Services markets. Will be responsible for taking inbound patient condition calls,  and making outbound triage assessment calls utilizing Briggs triage guidelines, assess patient needs and provide telephonic and virtual care to members. Coordinate any additional patient condition with the members assigned provider and provide any additional care coordination as identified with patient, caregiver, and providers

Key Responsibilities (List)     Key Responsibilities

Nursing Triage

 Assess and triage immediate health concerns transferred to nursing team by clinical support staff.

Provide telephonic nursing assessment and triage supported by triage protocols. This includes, timely and accurate triage documentation, escalation, and follow up.

Initiate medication changes and other orders, as directed by provider in response to a triage call.

Coordinate care with the primary care provider

The RN will direct all aspects of patient care before involving the provider. The RN will direct and support internal teams at working at the top of their licensure. RNs will place verbal/telephonic orders and rely on standing orders for independently placing orders for patient needs.

Escalate any patient conditions to the appropriate level of care

Provider Support

Completes telephonic nursing assessments including social determinants of health screenings, post hospital discharge screenings, triage, and other assessments assigned by provider

Assists with organizing and running a chronic care and/or interdisciplinary care team rounds where high risk patients and care plans are identified

Participate using a team approach to create a care plan for the patient

 Maintain and update spreadsheets and documents provided by health plan to prep weekly rounds of documentation

Additional Responsibilities as identified for patient care

Health Literacy Improvement

 Improves Health literacy and coaches consumers 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.

 Identifies problems or gaps in care, and offers opportunity for intervention

Coordinates services and referrals to health programs, and participates in patient education and outreach tied to HEDIS initiatives

Works to improve access to care, and works as part of the team to manage heath care cost and utilization

Transition of Care

Monitors daily discharge list and develops a plan to schedule transition of care visits within the allotted timeframe

Complete telephonic post-discharge hospital visits and ask pertinent discharge triage questions and complete medication reconciliation

Document all findings and make appropriate referrals to social work, pharmacy, case management and engagement

Post-Acute Management and Coordination

Participation in weekly care coordination with health plan case management as directed by market needs

 Referral Management Care Coordination and tracking of hospice consults within 24 hrs. of order placement

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 saidManages 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

  Active, unrestricted compact RN license in all states we provide services

  Ability to obtain compact license and/or additional state licensure as needed

 5+ years of experience as a Registered Nurse

 Proficient level of experience with Microsoft Office applications, and strong technical aptitude

 EMR experience and proficiency, preferred Epic EHR experience

 BSN or ADN degree

Preferred Qualifications

  Previous experience working with the geriatric population/ chronic condition experience

Home Health experience

 2+ years of Triage experience

  Case management experience

 Previous customer service experience

 Previous experience in a telephonic role

Highly organized, self-directed worker with an ability to function in high volume environment

 Strong verbal and written communication skills

Prior clinical experience in palliative care, end of life, hospice, oncology, ICU, geriatrics , ER, internal medicine is preferred.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 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 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.

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.