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Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Nurse Case Management Lead Analyst
Location
Washington
Posted
17 days ago
Salary
$77.5K - $129.1K / year
Seniority
Senior
Job Description
Nurse Case Management Lead Analyst
The Cigna Group
• 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 • 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
Job 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, dental
- 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
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