Provides advanced professional input to complex Case Management assignments/projects. Handles more complex, high acuity cases and/or account sensitive cases. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and maintaining cost-effective, quality care. Evaluates, recommends, and maintains relationships with inpatient and outpatient counseling/treatment facilities. Assesses employee counseling and treatment needs, recommending program adjustments as needed. May assist with designing and conducting training and educational seminars. Manages own caseload and coordinates all assigned cases. Acts as a team leader when implementing new tools or case management initiatives. Supports and guides junior professionals. Works independently, requiring only expert-level technical support. Exercises judgment in evaluating, selecting, and adapting techniques and procedures. Uses in-depth professional knowledge to develop models, procedures, and monitor trends within Case Management. A Master's Degree in a health-related field with current licensure may be required. #J-18808-Ljbffr Cigna
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