McAllen, United States
8 months ago
The Case Management Technician functions under the direction of the Supervisor, Care Coordination to conduct screening for case management services and to identify member needs for Care Coordination, and implement selected interventions according to program guidelines for members. Interacts with members, providers, and other Cigna staff to implement the program interventions, track and document the members progress, and evaluate the individual member outcomes. The Case Management Technician participates as assigned in performing outreach calls to:
Identify members immediate and future CM, Special needs, and Disease Management needs
Improve and/or maintain the members health status and quality of life.
Educate and empower the member to become effective in the self-management of their chronic illness. Increase members adherence to program guidelines by plan physicians
The Case Management Technician interacts with members, providers, and other Cigna staff to implement selected program interventions, document the activities, and refer to professional staff as appropriate and according to protocols
Conducts outbound member calls following scripted protocols meeting both productivity and performance expectations as identified by unit supervisor. Conducts all calls in a courteous and customer service friendly manner.
Verifies member eligibility in the Care Coordination program according to program guidelines.
Documents agreement to participate in Care Coordination program according to prepared script and protocols.
Using good listening skills conducts outreach calls collecting specific clinical and baseline data according to script, tools, and protocols. Refers member to a case manager when indicated by members response to questions.
Communicates directly with members in the Care Coordination program to identify needs, and provide information on health care access and preventive health interventions and screening.
Establishes member specific interventions to be provided according to program guidelines, and care plans.
Collaborates with member, Complex Case Manager RN/MSW, and Account Manager/Care Coordinator, and reports on member progress.
Enters member data into various software platforms.
Routes case to appropriate Cigna associates based on established guidelines.
Communicates case specific information as indicated to providers. Information includes, but is not limited to member identification number, status of health screens and immunizations.
Assists members with: obtaining physician appointments, and resolving transportation issues. Assists with the delivery of program materials to the members Assists with the generation and delivery of member correspondence
Documents activities and required data for the purpose of outcome measurement and reporting and program CQI.
Participates in program development activities and project work.
Performs other duties normally associated and consistent with this position including, but not limited to maintaining applicable regulations and standards required in the performance of this position, participating in regular continuing education, updating and developing policies and procedures, attending in-house meetings and rounds, etc.
Performs other related duties and projects as assigned.
Adheres to Cigna policies and procedures.
Supports and carries out the Mercy Mission & Values.
Attends required training on an annual basis.
Complies with Cigna and HIPAA confidentiality standards to protect the confidentiality of member information.