RN Nurse Case Management Senior Analyst- Cigna Medicare Clinical Operations
1 week ago
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
Position Summary:
Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.
Essential Duties and Responsibilities:- Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
- Uses an established set of criteria to evaluates and authorize the medical necessity of services.
- Provide notification of decisions in accordance with compliance guidelines.
- Coordinate with Medical Directors when services do not meet criteria or require additional review.
- Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
- Works with management team to achieve operational objectives and financial goals.
- Supports teams across UM Department as needed.
- Active participation and completion of all required trainings.
- Maintain Required Licensures
- Adherence to regulatory and departmental timeframes for review of requests
- Meet/exceed department Turn Around time, daily established productivity goals, and service levels
- Proficient knowledge of policies and procedures, Medicare, HIPPA and NCQA standards;
- Professional demeanor and the ability to work effectively within a team or independently;
- Flexible with the ability to shift priorities when required
- Holiday rotation (2 holidays per year)
- Other duties as required
Qualifications:
- Current RN license – Multi-State License Preferred
- Bachelor's degree in nursing or health-care related field preferred
- Minimum of 2 years' experience in a regulated environment preferred
- Minimum of 2-3 years clinical experience
- Strong customer orientation
- Strong organizational, planning, and communication skills
- Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus
- Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
- Excellent time management skills
Knowledge, Skills, Abilities Required:
- Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
- Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
- Able to work in a dynamic, fast-paced team environment and to promote team concepts
- Excellent typing skills.
- Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
-
Remote, Oregon, United States The Cigna Group Full timeJob DescriptionFor this position, Nurse Case Manager Senior Analyst, through the case management process, will:Promote the improvement of health outcomes to members.Assist those members experiencing the burdens of illness and injury.Assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs within case...
-
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Nurse Case Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Nurse Case Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Remote, Oregon, United States The Cigna Group Full timePosition Scope:Manages/coordinates an active caseload of case management cases for Cigna Medicare. Uses clinical knowledge to assess the treatment plan and goals, and identifies gaps in care or risks for readmission or complications.Establishes patient centric goals and interventions to meet the member's needsInterfaces with the member, family...
-
RN Nurse Case Management Senior Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeDelivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate...
-
RN Nurse Case Management Senior Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Nurse Case Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
RN Nurse Case Management Senior Analyst
3 days ago
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Nurse Case Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Remote, Oregon, United States The Cigna Group Full timeThe job title for this role is Nurse Case Management Senior Analyst, and it falls under the Band 3 Senior Contributor Career Track.Looking to advance in your career journey?We highly esteem our skilled employees, and we always strive to support their professional growth before seeking external candidates for open positions. If you believe the position you...
-
Remote, Oregon, United States The Cigna Group Full timeUnder general supervision, responsible for identifying high risk patients for case management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan, and community...
-
Remote, Oregon, United States The Cigna Group Full timeUnder general supervision, responsible for identifying high risk patients for case management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan, and community...
-
Case Management Analyst-3
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Case Management Analyst, which is a Band 2 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for...
-
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Intake Care Senior Representative, which is a Band 2 Professional Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right...
-
Medicare Grievances Senior Supervisor
2 weeks ago
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Customer Service Senior Supervisor, which is a Band 3 Management Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right...
-
Nurse Case Management Lead Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe 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 whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Network Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is...
-
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Network Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is...
-
Nurse Case Management Lead Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe 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 whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Oncology Nurse Case Management Lead Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe 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 whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see...
-
Case Management Senior Analyst
1 month ago
Remote, Oregon, United States The Cigna Group Full timeThe job profile for this position is Case Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is...
-
Medicare Telesales Director
1 month ago
Remote, Oregon, United States The Cigna Group Full timeWork Location: Remote - United StatesSummaryThe Direct to Consumer (DTC) Medicare channel is a significant driver of current and future growth and earnings for Cigna. Growth in the Medicare market coupled with consumer purchasing trends via the DTC channel provide significant opportunities for a leader to shape a significant component of the Medicare Growth...
