Case Management Analyst (LPN) - EviCore - Work at Home

Cigna in; Bloomfield (CT); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Case Management Analyst (LPN) to assist in specialty drug redirection and coordinate care with clients and providers. The role requires strong telephonic communication and organizational skills, along with a minimum of 2 years of LPN experience. Join a dynamic team and contribute to the health and well-being of patients while enjoying comprehensive benefits and a flexible work environment.

Benefits

Comprehensive health benefits

401(k) with company match

Paid time off

Annual bonus plan

Qualifications

• Minimum of 2 years LPN experience.
• Ability to communicate needs effectively to RN Case Manager and interdisciplinary team members.
• Strong telephonic communication skills.

Responsibilities

• Assist RN Case Manager on specialty drug redirection.
• Document findings in a clear, concise manner.
• Act as a liaison with clients and providers to coordinate care.

Skills

Time management

Organizational skills

Analytical skills

Interpersonal skills

Education

Graduate of approved LPN/LVN program

Unrestricted LPN/LVN license

Job description

Overview

Case Management Analyst (LPN) - EviCore - Work at Home (Finance)

The Case Management Analyst (LPN) will:

• Assist/collaborate with RN Case Manager on customers that require specialty drug redirection to meet an individual's healthcare needs.
• Through communication and available resources, complete administrative medical duties such as outreaching/collaborating with MD offices, confirming sites of care have all clinical information needed, authorization entry, medical cost savings details, and limited customer/patient outreach.
• Using available internal resources and through collaboration with Medical Directors, assist in network adequacy reviews for medical specialty drugs.
• Service calls in a warm and empathetic manner as the calls can be sensitive in nature.
• Apply problem-solving skills and intelligent judgment to assess the caller’s needs and collaborate with the RN for direction and intervention as necessary.
• Based upon the call type and requests, use customer service skills, knowledge of the specialty pharmacy processes, and Cigna training to address caller needs and issues/concerns.
• Utilize telephonic communication, web-based documentation and resources, and internal materials to assist in achieving successful redirection and coordination.
• Maintain collaboration and regular communication with the customer, prescriber, and alternate site of care to ensure timely coordination of redirection and customer needs. Time management is crucial.

Major Job Responsibilities and Required Results

• Establish a collaborative relationship with the customer, physician(s), and other providers to coordinate care.
• Document findings in a clear, concise manner.
• Act as a liaison with the account, client/family, physician(s), internal and external matrix partners, and facilities/agencies.
• Maintain an accurate record (in the system) of interventions including cost/benefit analysis, savings, and data collection.
• Adhere to quality assurance standards and all case management policy and procedures.
• Meet case volumes and turnaround times per policy.
• Interact with Medical Directors as needed in collaboration with the RN Case Manager.
• Interact with Care Associates, benefit specialists, Pharmacy Service Center, Accredo Specialty Pharmacy and claims staff for claim payment directions to ensure correct interpretation of current and future cost of care.
• Assist Sales Account Executive in communicating status and/or resolving issues for service center-based customers, as assigned.
• Participate on committees, task forces and other company projects, as assigned.
• Support training initiatives or audits of case files, as assigned.
• Demonstrate sensitivity to culturally diverse situations, clients and customers.
• Ensure the member’s privacy, confidentiality, and safety are maintained; adhere to ethical and accreditation standards; serve as a member advocate; and adhere to legal and regulatory standards.
• Access the various Cigna systems to obtain requested information such as eligibility, benefits, demographic information, discharge and clinical information, and available customer programs.
• Ensure complete and thorough research and documentation in network adequacy reviews for medical specialty drugs.
• Any other assigned tasks as deemed necessary to meet business needs.

Minimum Requirements

• Graduate of approved LPN/LVN program
• An unrestricted Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN) license in state of primary residence. Compact License preferred.
• Minimum of 2 years LPN experience.
• Hours: Monday - Friday; 8:00 am to 4:30 pm in candidate’s time zone.

Preferred Requirements

• Excellent time management, organizational, research, analytical, and interpersonal skills.
• Ability to communicate needs effectively to RN Case Manager, physicians’ offices, and interdisciplinary team members.
• Ability to meet deadlines, promote team concepts, manage multiple priorities, and adapt to complex, fast-paced environments.
• Ability to adapt to new workflows and tasks quickly.
• Knowledge of the insurance industry and knowledge of claims processing and specialty pharmacy.
• Effective listening and organizational skills.
• Ability to manage multiple tasks, setting priorities where needed.
• Ability to work independently, problem solve, and function without constant supervision.
• Prior experience in managed care/healthcare environment ideal.
• Excellent typing/computer skills with the ability to learn new software systems.
• Strong telephonic communication skills.
• Working knowledge of Cigna prior authorization and medical management systems.

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 10 Mbps download/5 Mbps upload.

For this position, we anticipate offering an hourly rate of 24 - 36 USD per hour, depending on relevant factors including experience and geographic location.

This role is anticipated to be eligible to participate in an annual bonus plan.

We offer a comprehensive range of benefits to support your whole health starting on day one, including medical, vision, dental, well-being and behavioral health programs. We also offer 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. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

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.

If you require reasonable accommodation in completing the online application process, please email: [e-mail] for support. Do not email [e-mail] for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.