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  • Full Time
  • Kenya

Website Cigna

The Nurse Case Advisor uses their clinical knowledge to conduct medical necessity reviews for the clinical services recommended to our customers and confirm they are medically necessary and can be covered under the client/customer’s policy terms and conditions.

A procedure is considered medically necessary when it is in line with the accepted care services and supplies provided by healthcare entities, is appropriate to the evaluation and treatment of a disease, condition, illness or injury and is consistent with the applicable standard of care as supported by evidence-based clinical standards.

Cigna utilizes the standards of care accepted worldwide, but due to our operating model, it also is crucial to understand and be compliant with local practices as determined by local or relevant health care authorities in the countries where we are operating.

  • Manages/coordinates an active volume of cases by providing information, navigation and coordination to customers worldwide.
  • Works with a multicultural population and is constantly aware of the cultural differences among that population.
  • Establishes patient-centric goals and interventions to meet the member’s needs
  • Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
  • Balances business needs with patient advocacy
  • Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
  • Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations
  • Maintains accurate workflow and processes documents
  • Adheres to professional practice within the scope of licensure and certification quality assurance standards and all case management policies and procedures
  • Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
  • Demonstrates sensitivity to culturally diverse situations, clients and customers.

Minimum requirements:

  • Bachelor in Nursing, 3-5 years of clinical experience ideally, in international clinical management
  • Demonstrated organizational and leadership skills
  • Strong interpersonal and communication skills
  • Demonstrates problem-solving and analytical skills.
  • Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
  • Ability to operate a personal computer, proficient with Microsoft office products, call centre software, and a variety of software.
  • Ability to build solid working relationships with staff, matrix partners, customers and providers

Language requirements:

  • English and French: read, write and speak fluently
  • Any other international language including Portuguese, German or Italian is a plus

Working Hours: Full flexibility across a daily shift that runs from 11 am to 8 pm local time

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centred care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

Qualified applicants will be considered without regard to race, colour, 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 a reasonable accommodation in completing the online application process, please email SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.

To apply for this job please visit jobs.cigna.com.

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