About this role
The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.
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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.
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.
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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Other facts
About The Cigna Group
The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health.
The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.
What you'll do
- The Nurse Case Management Lead Analyst provides advanced professional input to complex Nurse Case Management assignments and manages a caseload while coordinating all assigned cases. They ensure that case management program objectives are met and evaluate the effectiveness of alternative care services.
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