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

A leading healthcare company seeks a Nurse Case Manager to provide case management support and education to patients. This role involves managing a caseload, coordinating with clinical partners, and ensuring effective healthcare outcomes. Candidates should possess an Associate’s degree and a valid nursing license, along with relevant experience in healthcare settings. The position offers a competitive salary and comprehensive benefits.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401(k) with match

Paid Time Off

Tuition Reimbursement

Qualifications

• 2-5 years of relevant experience with prior authorization submission.
• 5-10 years’ experience in hospital settings preferred.

Responsibilities

• Provides case management support and education to patients.
• Manages own caseload and coordinates all assigned cases.

Skills

Communication

Teamwork

Multitasking

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 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 alternative 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's medical condition, restrictions, limitations, and expected duration. Performs leadership roles on teams when implementing new tools or case management programs/initiatives. Manages own caseload and coordinates all assigned cases. Supports and 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 and procedures and monitor trends within Nurse Case Management. RN and current unrestricted nursing license required.

Position Summary

Provides case management support and education to patients on assigned caseload via remote contact. Builds relationships, assists with navigating insurance and pharmacy protocols, and provides medication, referral, and disease state training.

• Builds relationships with patients throughout the program.
• Provides patient-centric education regarding treatment and disease states.
• Manages caseload, including schedule maintenance, adherence, scheduled calls/interactions, and database updates.
• Coordinates meetings between patients and clinical partners.
• Delivers customized interactions based on patient needs.
• Participates in customer meetings and training sessions.
• Participates in orientation meetings and demonstrates clinical and systems competency.
• Performs special projects and other duties related to contract performance.

Qualifications

• Associate’s degree and 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’ experience in hospital settings, pre-authorization, utilization review, or appeals preferred but not required.
• Experience with prior authorization appeals or denying claims for patients.
• Registered Nurse.
• Proficiency with Microsoft Office and basic database navigation.
• Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business.
• Ability to multitask across PC/Phone tasks.
• Effective teamwork skills; ownership of projects; strong relationship-building skills.
• Results-oriented with good prioritization and deadline management.
• Excellent verbal and written communication skills.

For remote work, internet must be broadband or fiber with speeds of at least 10Mbps download/5Mbps upload. Salary range is $76,600 - $127,600 annually, depending on experience and location. The role may be eligible for an annual bonus.

We offer comprehensive benefits including medical, vision, dental, wellness programs, 401(k) with match, paid life insurance, tuition reimbursement, at least 18 days of paid time off, and holidays. More details at Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates solutions to improve health and vitality. Join us in driving growth and improving lives.

We consider all qualified applicants regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, and other protected characteristics.

For accommodations, email [e-mail]. Do not email for application status or resumes.

The Cigna Group maintains a tobacco-free policy and may not hire tobacco/nicotine users in certain states. Qualified applicants with criminal histories will be considered per applicable laws.