[Hiring] Nurse Case Management Lead Analyst @The Cigna Group

Role Description

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 or case management.
• Proficiency with Microsoft Office; basic database navigation.
• Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business required.
• Ability to multitask in PC/Phone tasks.
• Teamwork and communication skills required.

Requirements

• 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.

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) with company match.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
• Eligible to participate in an annual bonus plan.