Rn/Lpn Case Managment Senior Supervisor- Work From Home, Philadelphia, Pa

Primary Function: Responsible for assisting the Health Services Manager / Clinical Program Manager in the development, implementation, and management of value based care nurse activities. Provides direct supervision for the daily operations of a team of VBCN Nurses.
Responsibilities:
Assists in carrying out the plans and daily operations of the VBCN department. Knowledgeable in workflow productivity and timelines standards for all disciplines providing services within VBCN department. Provides individual team and departmental leadership. Ensures that staff receives appropriate orientation and training to organizational and departmental policies and procedures and ensures that staff has the expertise to perform assigned duties.
Maintains a current knowledge of CareAllies Policies and Procedures, CMS requirements, NCQA standards and recommendations, and provides oversight and coordination of CareAllies programs in accordance with these policies and standards.
Functions as a member of the interview team in assessing candidates and ensures that minimal qualifications are met. Participates in training and education of new and existing staff.
Works collaboratively with the Health Services Manager / Clinical Program Manager to prepare reports and conduct analysis of operations/services as required by departmental, corporate, and/or regulatory requirements.
Performs quality audits per policy for assigned staff. Shares audit results with associates and provides necessary education and counseling to improve performance.
Makes recommendations to the Health Services Manager / Clinical Program Manager for annual performance evaluations of all assigned staff. Uses objective and measurable performance measures. Submits evaluations on time. Develops, implements, and monitors associates placed on performance improvement plans under the direction of the Health Services Manager / Clinical Program Manager.
Participates in current process review and development of new and/or revised work processes, policies and procedures relating to VBCN responsibilities. Provides input into the development of educational materials and programs necessary to meet CareAllies business objectives, member's needs, and regulatory guidelines and staff professional development.
Acts as a liaison for CareAllies with outsides entities, including, but not limited to physicians, hospitals, health care vendors, social service agencies, member advocates, regulatory agencies.
Creates and supports an environment which fosters teamwork, cooperation, respect, and diversity. Establishes and maintains positive communication and professional demeanor with CareAllies employees and members at all times. Demonstrates and supports commitment to corporate goals and objectives.
Complies with Corporate, Federal, and State confidentiality standards to ensure the appropriate protection of member identifiable health information.
Responsible for ensuring VBCNs are completing all job duties in assigned PCP offices.
Attends all monthly provider meetings for assigned PODs.
Maintains all necessary educational requirements for required licensure and certifications.
Performs other related duties and projects as assigned.
Adheres to CareAllies policies and procedures.
Supports and carries out the CareAllies Mission & Values.
Attends required training on an annual basis.
Supervisory Responsibilities:
Hires, monitors performance, evaluates and manages VBCN personnel in conjunction with Health Services Manager, Clinical Program Manager and V/P of Health Services.
Job Related Skills:

• Demonstrates critical thinking and problem solving skills
• Excellent verbal and written communications skills
• Excellent organizational and time management skills
• Proved ability to organize complex processes involving multiple, detailed tasks and people. Ability to manage multiple assignments, meet deadlines and manage schedule
• Demonstrates ability to resolve conflict among team members and achieve common team goals
• Ability to influence those who do not directly report to this position
• Ability to present technical overview to internal and external audiences in a clear way
• Typing and computer knowledge
• Knowledge of health insurance industry and processes

Position Qualifications/Requirements:
Education and Training:
RN or LVN/LPN - Current active and valid Philadelphia and Maryland License as a Registered Nurse or Licensed Vocational Nurse/Practical Nurse.
Experience:
3 - 5 years RN experience
2 - 3 supervisor or teamlead proven experience
Minimum of 5 years progressively responsible experience in a clinical environment, including utilization management, case management, or discharge planning experience. Previous experience with HEDIS reviews and CMS STARs program preferred. Previous management experience preferred.
Must willing to travel to Maryland quarterly.
Must have knowledge of Philadelphia and Maryland Market.
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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.