Lead Analyst for Nurse Case Management

1 week ago

Nashville, Tennessee, United States Cigna Full time
Position Overview:
  • Oversees and coordinates a dynamic caseload of case management cases for Cigna Medicare. Utilizes clinical expertise to evaluate treatment plans and objectives, identifying care gaps or potential risks for readmission or complications.
  • Sets patient-focused goals and strategies to address the needs of members.
  • Engages with members, their families or caregivers, and the healthcare team, including embedded care coordinators and internal partners.
  • Fosters strong working relationships with internal staff, key functional areas, customers, and healthcare providers.
  • Ensures that the objectives of the case management program are achieved by assessing the effectiveness of alternative care services while maintaining cost-effective, high-quality care.
  • Takes a leadership role in the team during the implementation of new tools or case management initiatives.
  • Manages personal caseload and coordinates all assigned cases.
  • Provides guidance and support to junior professionals.
  • Operates independently, requiring only 'expert' level technical support from others.
  • Employs extensive professional knowledge and insight to develop models and procedures, and to monitor trends within Nurse Case Management. A current, unrestricted nursing license is mandatory.
Position Summary:

The Nurse Case Management Lead Analyst will enhance health outcomes for members through the case management process, assisting those facing the challenges of illness and injury. This role involves assessing, planning, implementing, coordinating, monitoring, and evaluating options and services tailored to meet individual health needs. The Case Manager will advocate for quality, cost-effective outcomes by managing care needs throughout the continuum of care, utilizing effective communication skills and a consumer-focused approach through education and health advocacy. The Case Manager will ensure compliance with all Medicare and DSNP model of care requirements and will effectively communicate with both internal and external customers in a telephonic environment. The team lead will act as a resource and collaborator on complex cases and will mentor new hires and junior staff.

Key Responsibilities:
  • Establishes collaborative relationships with clients (plan participants/members), families, physicians, and other providers to assess medical history and current health status, determining options for optimal outcomes.
  • Promotes consumer engagement through education and health advocacy.
  • Evaluates members' health status and treatment plans, identifying any barriers to healthcare. Develops a documented, patient-centered case management plan involving all relevant parties (clients, physicians, providers, employers, etc.), outlining anticipated outcomes, criteria for case closure, and facilitating communication among all involved.
  • Implements, coordinates, monitors, and evaluates the case management plan on an ongoing basis.
  • Adheres to professional practice standards within the scope of licensure and certification, ensuring quality assurance and compliance with all case management policies and procedures.
  • Participates in training initiatives and demonstrates commitment to continuing education to maintain clinical expertise and certification as necessary.
  • Exhibits sensitivity to culturally diverse situations, clients, and customers.
Work Schedule:

Monday to Friday, 8:00 AM - 5:00 PM

Minimum Qualifications:

Active, unrestricted Registered Nurse (RN) Multi-State License. Willingness to obtain licensure in non-Compact states as required. A minimum of two years of full-time equivalent direct clinical care experience is essential.

Preferred Qualifications:
  • Experience in training and staff development.
  • Strong communication, interpersonal, and analytical skills.
  • Excellent time management, organizational, research, and negotiation abilities.
  • Familiarity with the insurance industry and claims processing.
  • Proficiency in basic document, spreadsheet, internet, and email applications.
  • Ability to thrive in a fast-paced and evolving business environment.
  • Capacity to build solid working relationships with staff, customers, and providers.
  • Demonstrated experience in process improvement.
Core Competencies:
  • Exceptional time management, organizational, research, analytical, negotiation, communication (oral and written), and interpersonal skills.
  • Proficient in personal computer applications, including MS Word, Excel, Outlook, and internet research.
  • Strong abilities in teamwork, conflict resolution, complex issue assessment, and effective decision-making.
  • Experience in medical management and case management within a managed care context is highly desirable.
  • Knowledge of managed care products and strategies.
  • Demonstrated sensitivity to culturally diverse situations, participants, and customers.
If working from home, a reliable internet connection is required, with a minimum speed of 10Mbps download and 5Mbps upload.

About Cigna Healthcare:

Cigna Healthcare, a division of The Cigna Group, is dedicated to advocating for better health throughout every stage of life. We empower our customers with the information and insights necessary to make informed choices for enhancing their health and well-being.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, 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.

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