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

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

Job summary

A leading healthcare company is seeking a Nurse Case Manager to provide advanced case management support and education to patients. The role involves managing a caseload, coordinating care, and ensuring effective healthcare outcomes. Candidates should have a nursing license and relevant experience in case management. Comprehensive benefits and competitive salary range offered.

Benefits

Health coverage

401(k) with match

Paid time off

Qualifications

• 2-5 years of relevant experience with prior authorization submission.
• 5-10 years of hospital or pre-authorization experience preferred.

Responsibilities

• Provides case management support and education to patients.
• Builds relationships with patients and coordinates meetings.

Skills

Communication

Teamwork

Multitasking

Relationship Building

Results-oriented

Education

Associate's degree

Tools

Microsoft Office

CoverMyMeds

Job description

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 the 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 care services and maintaining cost-effectiveness. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine the extent and impact of insured medical conditions, restrictions, limitations, and expected duration. Performs leadership roles on teams when implementing new tools or case management programs/initiatives. Manages own caseload, coordinates all assigned cases, and supports or provides guidance to junior professionals. Works autonomously, requiring only expert-level technical support from others. Exercises judgment in evaluating, selecting, and adapting techniques and procedures. Uses in-depth professional knowledge to develop models, monitor trends within Nurse Case Management, and ensure quality outcomes. RN and current unrestricted nursing license required.

Position Summary

Provides case management support and education to patients on assigned caseload via remote contact. This includes relationship building, navigating insurance and pharmacy protocols, and providing disease state and product training.

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

Qualifications

• Associate's degree and a current, valid nursing license in the state of practice.
• 2-5 years of relevant experience with prior authorization submission using tools like CoverMyMeds.
• 5-10 years of hospital or pre-authorization experience, utilization review, or appeals (preferred but not required).
• Experience with prior authorization appeals or claims denials.
• Proficiency with Microsoft Office and basic database navigation.
• Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business.
• Ability to multitask across PC and phone tasks.
• Effective teamwork, ownership of projects, and relationship-building skills.
• Results-oriented with strong prioritization skills.
• Excellent verbal and written communication skills.

If working remotely, a broadband internet connection of at least 10Mbps download and 5Mbps upload is required.

Anticipated annual salary ranges from $76,600 to $127,600, depending on experience and location, with eligibility for an annual bonus plan.

We offer comprehensive benefits, including health coverage, 401(k) with match, paid time off, and more, starting from day one. For details, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth, a division of The Cigna Group, develops pharmacy, care, and benefit solutions to improve health and vitality. We innovate to make illness prediction, prevention, and treatment more accessible. Join us to drive growth and improve lives.

We are an equal opportunity employer and consider all qualified applicants without regard to race, color, age, disability, sex, religion, or other protected characteristics.

For accommodations during the application process, email [e-mail]. Please note, the company has a tobacco-free policy and considers criminal histories in employment decisions as per applicable laws.