Nurse Case Management Lead Analyst
The Cigna Group
full-time
Posted on:
Location Type: Remote
Location: Alabama • Alaska • United States
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Salary
💰 $77,500 - $129,100 per year
Job Level
About the role
- 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 to facilitate appropriate healthcare outcomes for members
- Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services
- 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
- 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 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
Requirements
- 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
Benefits
- Medical, vision, and dental benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Nurse Case Managementhealth care services planningclinical assessmentprospective reviewsconcurrent reviewsretrospective reviewscase management program evaluationmedical condition evaluationmodel developmentprocedure adaptation
Soft Skills
leadershipautonomyjudgmentmultitaskingdirection provision
Certifications
Registered Nurse (RN) licenseBSNCompact nursing license