Nurse Case Management Lead Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $77.5k - $129.1k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Provide advanced professional input to complex Nurse Case Management assignments and projects • Plan, implement, and evaluate appropriate health care services in conjunction with physician treatment plans • Handle complex, high-acuity, and account-sensitive cases involving the largest reserves • Assess, plan, implement, coordinate, monitor, and evaluate healthcare options and services to facilitate appropriate member outcomes • Evaluate alternative care services to ensure program objectives, cost-effective care, and quality care are maintained • Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services • Review initial liability disability claims to determine the impact of medical conditions, restrictions, limitations, and expected duration • Provide team leadership when implementing new tools or case management programs and initiatives • Manage own caseload and coordinate assigned cases • Support and provide direction to junior professionals • Work autonomously and apply expert technical judgment • Develop models and procedures and monitor trends within Nurse Case Management

🎯 Requirements

• Registered Nurse (RN) license in state of primary residence • Minimum 2 years of nursing experience in prior authorizations or case management preferred • Proficiency with Microsoft Office • Basic database navigation • Knowledge of pharmacy and pharmaceuticals preferred • Ability to manage multiple priorities • Ability to work independently and collaborate effectively across teams • Home internet connection through cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload if working at home occasionally or permanently

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Remote work / work-at-home arrangement