Senior Case Management Analyst

🔥 14 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

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

• 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 establish goals and track health outcomes • Coordinate services across inpatient, rehabilitation, outpatient, and preventive settings • Adjust care plans as member 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 • Strong skills in care planning, care coordination, and patient advocacy across the continuum of care • Clear, respectful written and verbal communication • Comfort using a PC, Windows, and Word, with ability to learn new systems • Previous case management experience preferred • Certified Case Manager (CCM) credential preferred, or ability to obtain within 12 months of hire • Experience interpreting benefit plan documents and applying guidelines preferred • Quality improvement or training/mentorship experience preferred • 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 on 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-at-home arrangement • Cable broadband or fiber optic internet requirement for home working