Job Description

Position Scope

Care Navigators are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers and families.

Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

• Customer Strong: I deliver world-class experiences for all my customers.
• Me to We: I take accountability to trust, partner, and deliver.
• Own It: I see a need and deliver value because I care.
• Evolve and Adapt: I learn and adapt to meet evolving business needs.
• Be Bold: I pioneer and think broadly to solve challenges.
• Take Care: I prioritize self-care and act with compassion toward colleague.

Day in the Life Responsibilities

• Bridges gaps in care and assesses/troubleshoots barriers to care. (Includes PCP access, ER visits and inpatient admits)
• Collaborates with case management, pharmacist, behavioral clinician, Medical Director, and member\'s provider to provide whole-person health support.
• Participate and collaborate in an innovative, targeted program that drives improved outcomes for a high-needs population.
• Assesses for, and facilitates resources, to aid/assist with Social Determinants of Health needs.
• Engagement of high-risk members evaluating for plan of care to direct members to appropriate resources and clinical programs.
• 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.
• Provide in-the-moment telephonic support that may encompass medical, behavioral, and social needs.
• Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
• Participates in rapid-cycle improvement processes with daily work/focus shifting to meet member trends.
• Empowers customers with skills to enhance interaction with their providers.
• Research relevant topics in health promotion and disease prevention, as required for specific customer.
• Tracks daily activities to trend volume and outcomes.
• Follows standard operating procedures.
• Toggles between multiple systems and applications.
• Prioritizes work to meet commitments aligned with organizational goals.
• Understands and adheres to organizational performance measures to deliver on key results.
• Completes training within the communicated time limit as required per role.
• Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Proactive, nimble, and problem solving to resolve immediate customer needs.
• Assesses for, and facilitates resources, to aid/assist with Social Determinants of Health needs.

Minimum requirements:

Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Minimum of two years full-time direct patient care as an RN required.

Preferred requirements:

• Previous experience in Medicaid and/or Marketplace/Accountable Care plans.
• Managed Care Insurance experience,
• Skilled in assisting members with navigation and coordination of care within the health care system.
• Strong understanding of health disparities/SDOH and their impact on overall health outcomes.
• Experience in home care or healthcare clinic setting that included the underserved or uninsured.
• Previous experience with (one or more) behavioral health, diabetes education, population health, public health, or quality/HEDIS measures.
• Adapts approach in real time to match the agile demands of multiple initiatives.
• Ability to manage multiple, complex situations in a challenging environment by collaborating with clinical and other business partners.
• Skilled in clinical acumen to form a judgement and act.
• Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
• Demonstrates sensitivity to culturally diverse situations, participants, and customers.
• Demonstrates effective organizational skills and flexibility to meet the business needs.
• Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
• Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.

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.

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