Senior Case Management Analyst

🔥 23 hours ago

🇺🇸 United States – Remote

💵 $57.6k - $96k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Lead complex case planning from intake through resolution • Align clinical needs, benefits, and community resources to support safe, timely care • Partner with members, families, providers, and internal teams to set goals and track health outcomes • Coordinate services across inpatient, rehabilitation, outpatient, and preventive settings • Adjust care plans as members' needs change • Use utilization review and documentation to ensure services meet criteria and benefits are maximized • Coach members on conditions, treatment options, and next steps • Escalate quality-of-care and complex clinical questions to the Medical Director • Support quality reviews and lead risk meetings as needed • Mentor new team members

🎯 Requirements

• Active RN license (state-appropriate) • Associate degree in nursing (ASN) or higher • Compact license required if living in a Nursing Compact state • Minimum 3 years of recent clinical practice experience in Oncology, Behavioral Health, In-patient, Critical Care, or Med/Surg • Skills in care planning, care coordination, and patient advocacy across the continuum of care • Clear, respectful written and verbal communication • Comfort using a PC and common tools, including Windows and Word • Ability to learn new systems as they change • Preferred: previous case management experience in a health plan, employer, or clinical setting • Preferred: Certified Case Manager (CCM) credential or ability to obtain within 12 months of hire • Preferred: experience interpreting benefit plan documents and applying guidelines • Preferred: quality improvement or training/mentorship experience • Home internet through cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Work-from-home arrangement