- job requisition id
- 26003365
The Nurse Case Management Lead Analyst will:
- Provides advanced professional input to complex Nurse Case Management assignments/projects.
- Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
- Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves.
- Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.
- Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
- Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
- May review initial liability disability claims to determine extent and impact of insured’s medical condition, medical restrictions and limitations and expected duration.
- Performs leadership role on team when implementing new tools or case management programs/initiatives.
- Manages own caseload and coordinates all assigned cases. Supports and provides direction to more junior professionals.
- Works autonomously, only requiring “expert” level technical support from others.
- Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
- Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.
Qualifications:
- Registered Nurse (RN) license in state of primary residence.
- BSN preferred.
- Compact nursing license preferred.
- Minimum 2 years of nursing experience in prior authorizations preferred.
- Knowledge/experience with Appeals preferred.
- Proficiency with Microsoft Office; basic database navigation.
- Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business preferred.
- Ability to multitask in PC/Phone tasks.
- Teamwork and communication skills required.
- Hours: Varied within different time zones.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 77,500 – 129,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, 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 need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
