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

The Cigna Group; United States; Remote; USD 76,000 - 128,000; Full time

Job summary

An established industry player is seeking a Nurse Case Management Lead Analyst to provide advanced professional input in complex case management. This role involves planning and evaluating healthcare services, managing high acuity cases, and supporting patients through remote contact. The ideal candidate will have a nursing license and experience in prior authorization and utilization review. Join a forward-thinking organization that values its employees and offers comprehensive benefits, including medical, dental, and a 401(k) plan. This is a fantastic opportunity to grow your career while making a significant impact on patient care.

Benefits

Comprehensive Medical Benefits

Vision and Dental Insurance

401(k) Plan

Paid Time Off

Well-being Programs

Qualifications

• 2-5 years of experience in prior authorization submission.
• Knowledge of pharmacy and healthcare business is essential.

Responsibilities

• Provides patient-centric education on treatment and disease states.
• Manages caseload and coordinates meetings between patients and clinical partners.

Skills

Prior Authorization Submission

Utilization Review

Effective Teamwork

Communication Skills

Multitasking

Education

Associate's Degree in Nursing

Tools

CoverMyMeds

Microsoft Office

Job description

The job profile for this position is Nurse Case Management Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees and strive to help our associates grow professionally before recruiting new talent. If you see a position that fits your profile, we encourage you to apply!

Our people make all the difference in our success.

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 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 medical condition impact, restrictions, limitations, and expected duration. Takes a leadership role on the team when implementing new tools or case management programs/initiatives. Manages own caseload, coordinates cases, supports, and provides guidance to junior professionals. Works autonomously, requiring expert technical support from others. Uses in-depth professional knowledge to develop models, monitor trends, and improve Nurse Case Management practices. RN license is required.

Position Summary

Supports and educates patients on caseload through remote contact. Builds relationships, assists with insurance and pharmacy protocols, and provides disease state and product training.

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

Qualifications

• Associate’s degree and current, valid nursing license.
• 2-5 years of experience with prior authorization submission, using tools like CoverMyMeds.
• 5-10 years in hospital settings or pre-authorization, utilization review, and appeals (preferred but not required).
• Experience with appeals or denying claims.
• 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 strong relationship skills.
• Results-oriented with good prioritization and meeting deadlines.
• Excellent verbal and written communication skills.

For remote work, internet must be broadband or fiber with at least 10Mbps download and 5Mbps upload speeds.

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

We offer comprehensive benefits including medical, vision, dental, well-being programs, 401(k), paid time off, and more. Details available at Life at Cigna.

Qualified applicants are considered without regard to protected characteristics, and criminal history considerations are in line with laws.