Remote nurse case management lead analyst role with Cigna's Evernorth division. Handles complex, high-acuity cases, performs prospective/concurrent/retrospective reviews, and supports junior staff. Requires an active RN license in the state of primary residence; BSN and compact license preferred.
Job 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 preferred.
Proficiency with Microsoft Office; basic database navigation.
Knowledge of pharmacy, pharmaceuticals, preferred.
Ability to manage multiple priorities, work independently. and collaborate effectively across teams.
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.