RN Nurse Case Management Lead Analyst - Accredo - Work from Home , Anywhere, USA

Cigna in; Bloomfield (CT); Remote; USD 76,000 - 128,000; Full time

Job summary

A leading healthcare company is seeking an RN Nurse Case Management Lead Analyst to provide case management support and education to patients remotely. The role involves managing complex cases, coordinating with clinical partners, and ensuring effective healthcare outcomes. Candidates should have a nursing license and relevant experience in healthcare settings. Competitive salary and benefits are offered.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401(k) with match

Paid Time Off

Holidays

Qualifications

• 2-5 years of prior authorization experience using CoverMyMeds or similar tools.
• 5-10 years' experience in hospital settings or pre-authorization, utilization review, and appeals.

Responsibilities

• Provides case management support and education to patients remotely.
• Builds relationships with patients and assists with navigating insurance protocols.
• Manages own caseload and supports junior professionals.

Skills

Communication

Teamwork

Multitasking

Education

Associate's degree

Tools

Microsoft Office

CoverMyMeds

Job description

RN Nurse Case Management Lead Analyst - Accredo - Work from Home, Anywhere, USA (Finance)

Job Description Summary

Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate healthcare services in conjunction with the physician treatment plan. Handles more complex, high acuity cases, and/or account-sensitive cases involving large 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 care services and maintaining cost-effectiveness. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and outpatient services. May review initial liability disability claims to determine the extent and impact of the insured's medical condition, restrictions, limitations, and expected duration. Acts as a leader on the team when implementing new tools or programs. Manages own caseload and supports junior professionals. Exercises judgment in evaluating and adapting techniques and procedures, developing models, and monitoring trends within Nurse Case Management. RN and current unrestricted nursing license required.

Position Summary

Provides case management support and education to patients remotely. Builds relationships, assists with navigating insurance and pharmacy protocols, and offers disease state and medication training.

• Builds relationships with patients throughout the program.
• Provides education regarding treatment and disease states.
• Manages caseload, schedules, and updates records per protocols.
• Coordinates meetings between patients and clinical partners.
• Delivers customized interactions based on patient needs.
• Participates in training and program-specific meetings.
• Performs special projects related to contract performance.

Qualifications

• Associate's degree and current, valid nursing license.
• 2-5 years of prior authorization experience using CoverMyMeds or similar tools.
• 5-10 years' experience in hospital settings or pre-authorization, utilization review, and appeals (preferred but not required).
• Experience with prior authorization appeals or denials.
• Proficiency with Microsoft Office and basic database navigation.
• Knowledge of pharmacy, pharmaceuticals, or healthcare business.
• Ability to multitask effectively.
• Strong teamwork and communication skills.

For remote work, a broadband internet connection with at least 10Mbps download and 5Mbps upload is required.

Salary range: $76,600 - $127,600 annually, depending on experience and location. Eligible for an annual bonus plan.

Benefits include medical, vision, dental, well-being programs, 401(k) with match, paid time off, holidays, and more. For details, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth, a division of The Cigna Group, offers pharmacy, care, and benefit solutions to improve health and vitality. Join us in driving growth and improving lives.

We are an equal opportunity employer. Reasonable accommodations are available; contact [e-mail] for support. We have a tobacco-free policy, and candidates in certain states must meet specific criteria regarding tobacco use. Criminal history considerations are in accordance with laws.