Nurse Case Management Lead Analyst - Accredo - Work at Home

Cigna Healthcare

3d • Remote

About The Position

The Nurse Case Management Lead Analyst will: Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care 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 in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration. Performs leadership role on team when implementing new tools or case management programs/initiatives. Manages own caseload and coordinates all assigned cases. Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.

Requirements

• Registered Nurse (RN) license in state of primary residence.
• Minimum 2 years of nursing experience in prior authorizations or case management.
• Proficiency with Microsoft Office; basic database navigation.
• Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business required.
• Ability to multitask in PC/Phone tasks.
• Teamwork and communication skills required.
• 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 10Mbps download/5Mbps upload.

Nice To Haves

• BSN preferred.
• Compact nursing license preferred.

Responsibilities

• Provides advanced professional input to complex Nurse Case Management assignments/projects.
• Plans, implements, and evaluates appropriate health care 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 in order to facilitate appropriate healthcare outcomes for members.
• Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
• Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
• May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration.
• Performs leadership role on team when implementing new tools or case management programs/initiatives.
• Manages own caseload and coordinates all assigned cases.
• Supports and provides direction to more junior professionals.
• Works autonomously, only requiring “expert” level technical support from others.
• Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
• Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.

Benefits

• Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed