Cigna Medicare Clinical Operations Case Management Analyst LPN
6 hours ago
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) Weekend rotation Other duties as required Qualifications: Current unrestricted LPN/LVN license – Multi-State License Preferred Minimum of 1 year experience in a regulated environment preferred Minimum of 2+ 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 Proficient in basic computer 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 and computer skills. Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word. 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. For this position, we anticipate offering an hourly rate of 23 - 34 USD / hourly, depending on relevant factors, including experience and geographic location. 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 Group . About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. 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. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
-
Clinical Operations Case Manager LPN
3 weeks ago
West Bloomfield Township, Michigan, United States The Cigna Group Full timePosition SummaryWe are seeking a skilled LPN to join our team as a Clinical Operations Case Manager. In this role, you will collaborate with healthcare providers, members, and business partners to optimize member benefits, evaluate medical necessity, and promote effective use of resources.Key Responsibilities:Conduct medical necessity reviews for inpatient...
-
West Bloomfield Township, Michigan, United States Cigna Full timeJob SummaryWe are seeking a highly skilled LPN to join our team as a Clinical Operations Case Management Analyst. In this role, you will be responsible for collaborating with healthcare providers, members, and business partners to optimize member benefits, evaluate medical necessity, and promote effective use of resources.Key ResponsibilitiesConduct medical...
-
Nurse Case Manager Senior Analyst
2 weeks ago
West Bloomfield Township, Michigan, United States The Cigna Group Full timeAbout the RoleThis position, the Nurse Case Manager Senior Analyst, plays a critical role in promoting the improvement of health outcomes for members and assisting those experiencing the burdens of illness and injury through the case management process.Key ResponsibilitiesEstablishes a collaborative relationship with clients, family, physicians, and other...
-
Nurse Case Management Senior Analyst
3 weeks ago
West Bloomfield Township, Michigan, United States The Cigna Group Full timeJob SummaryThe Cigna Group is seeking a highly skilled Nurse Case Management Senior Analyst to join our team. As a key member of our case management team, you will play a critical role in promoting quality, cost-effective outcomes for our members.Key ResponsibilitiesEstablish and maintain collaborative relationships with clients, families, physicians, and...
-
Aviation Operations Lead Analyst
5 days ago
Bloomfield, Connecticut, United States Cigna Corporation Full timeJob SummaryWe are seeking a highly skilled Aviation Operations Lead Analyst to join our team at Cigna Corporation. As a key member of our Aviation and Overpayment Identification and Recovery Operations (OR) Commodities team, you will be responsible for sourcing activities and associated strategies across the Aviation and OR Commodities.Key...
-
Medicare Provider Data Quality Specialist
2 weeks ago
Bloomfield, Connecticut, United States The Cigna Group Full timeAbout the RoleThe Cigna Group is seeking a highly skilled Medicare Provider Data Quality Specialist to join our team. As a key member of our Provider Data Quality & Accuracy (PDQA) team, you will play a critical role in supporting the Internal Monitoring function.Key ResponsibilitiesSupport the development and implementation of a comprehensive internal audit...
-
Bloomfield, Connecticut, United States Cigna Full timeAbout the Cigna Group Sales and Contracting Development ProgramThe Cigna Group's Sales and Contracting Development Program is an intensive multi-week training program designed for early career hires, focused on developing business acumen, negotiation, and relationship building skills required to quickly onboard and contribute to The Cigna Group's focus on...
-
RN- Transplant Nurse Case Manager
2 weeks ago
Bloomfield, Connecticut, United States The Cigna Group Full timeAbout the RoleWe are seeking a highly skilled RN- Transplant Nurse Case Manager to join our team at The Cigna Group. As a RN- Transplant Nurse Case Manager, you will play a critical role in coordinating and managing the care of our customers with transplant needs.Key ResponsibilitiesCollaborate with customers to create personalized care plans and document...
-
Chief Privacy Counsel
1 week ago
Bloomfield, United States Cigna Full timeReporting to the Chief Privacy and Innovation Governance Officer, the Chief Privacy Counsel will lead the Privacy Legal team; counsel on high-profile issues related to privacy, cybersecurity, data use, and technology matters; and partner closely with IT, Cigna Information Protection, Data Governance, Digital & Analytics, Government Affairs, and Enterprise...
-
Chief Privacy Counsel
2 weeks ago
Bloomfield, United States Cigna Full timeReporting to the Chief Privacy and Innovation Governance Officer, the Chief Privacy Counsel will lead the Privacy Legal team; counsel on high-profile issues related to privacy, cybersecurity, data use, and technology matters; and partner closely with IT, Cigna Information Protection, Data Governance, Digital & Analytics, Government Affairs, and Enterprise...
-
Nurse Case Manager Senior Analyst
2 weeks ago
Bloomfield, Connecticut, United States The Cigna Group Full timeAbout the RoleThis position, the Nurse Case Manager Senior Analyst, plays a critical role in promoting the improvement of health outcomes for members and assisting those experiencing the burdens of illness and injury.Key ResponsibilitiesAssess, plan, implement, coordinate, monitor, and evaluate options and services to meet an individual's health needs within...
-
Clinical Pharmacist
1 week ago
Bloomfield, Connecticut, United States The Cigna Group Full timeClinical Pharmacist Job DescriptionCigna Healthcare is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will play a critical role in providing pharmaceutical care services to ambulatory care patients in a clinical setting.Key Responsibilities:Provide direct face-to-face or telephonic pharmaceutical care services to...
-
Transplant Nurse Case Manager
1 week ago
Bloomfield, Connecticut, United States The Cigna Group Full timeAbout the RoleWe are seeking a highly skilled Transplant Nurse Case Manager to join our team at The Cigna Group. As a key member of our healthcare team, you will play a vital role in coordinating and guiding care for our customers, families, and caregivers.Key ResponsibilitiesCollaborate with customers to create personalized care plans and document them in...
-
West Bloomfield Township, Michigan, United States Cigna Full timeJob Title: Category Management Lead Analyst: Aviation/ Overpayment Recovery OperationsReports To: Category Director, Pharmacy & Enterprise OperationsJob Summary:This role is part of the team responsible for sourcing activities and associated strategies across the Aviation and Overpayment Identification and Recovery Operations (OR) Commodities. The Category...
-
Bloomfield, United States Cigna Full timeMarketing Lead Analyst, Individual and Family Plans Small Group Segment - Hybrid ROLE SUMMARY A key resource on the customer retention marketing team, this position will support the Individual and Family Plans, Small Group business unit with responsibility for developing and executing legally required customer communication campaigns. Working with the...
-
Clinical Content Analyst
4 days ago
Bloomfield, Connecticut, United States The Cigna Group Full timeClinical Content Internship OpportunityWe are seeking a highly motivated and detail-oriented Clinical Content Intern to join our team at The Cigna Group. As a Clinical Content Intern, you will have the opportunity to work on a variety of projects that will help you develop your skills and knowledge in the field of clinical content.Responsibilities:Conduct...
-
Software Engineering Senior Advisor
3 weeks ago
Bloomfield, Connecticut, United States CIGNA Full timeJob SummaryThe Software Engineering Senior Advisor role is a Band 4 Senior Contributor Career Track Role with Cigna-Evernorth Services, Inc.Key ResponsibilitiesSupport and enhance existing Dental Claims Processing applications used by consumers and operational staff.Leverage existing open-source frameworks, third-party components, and libraries, as well as...
-
Risk Management Professional
4 weeks ago
Bloomfield, Connecticut, United States Cigna Full timeAbout the RoleCigna Healthcare is seeking a highly skilled and motivated individual to join our Risk Management & Underwriting Leadership Development Program (RULDP). As a key member of our team, you will play a critical role in evaluating the risk of insuring potential customers and setting premium rates for insurance coverage.Key ResponsibilitiesEvaluate...
-
Utilization Review Nurse
1 week ago
Bloomfield, Connecticut, United States The Cigna Group Full timeAbout the RoleWe are seeking a highly skilled Utilization Review Nurse to join our team at The Cigna Group. As a key member of our Appeals and Grievances team, you will play a critical role in ensuring that our members receive the best possible care and support.Key ResponsibilitiesConduct thorough reviews of medical records and other relevant documentation...
-
Actuarial Internship
1 month ago
Bloomfield, United States Cigna Part timeA summer internship with The Cigna Group's Actuarial Executive Development Program (AEDP) gives you an 11-week experience focused on learning about a career as an actuary at our company. In fact, the internship is The Cigna Group's main pathway for hiring full time talent. During the internship, you are asked to apply your analytical and technical skills, as...
