Nurse Case Management Sr. Analyst

About the position The Nurse Case Management Senior Analyst position at Cigna Group is a critical role focused on improving health outcomes for members through effective case management. The primary responsibility of the Case Manager is to assist members who are experiencing the burdens of illness and injury by assessing, planning, implementing, coordinating, monitoring, and evaluating options and services tailored to meet individual health needs. This role requires a comprehensive understanding of the case management process and the ability to work collaboratively with clients, families, physicians, and other healthcare providers to ensure optimal health outcomes. In this position, the Case Manager will establish a documented patient-centric case management plan that involves all relevant parties, including clients, physicians, and providers. The Case Manager will also identify any gaps or barriers to healthcare and promote consumerism through education and health advocacy. The role demands effective verbal and written communication skills, as well as the ability to work independently in a telephonic environment. The Case Manager will be responsible for monitoring and evaluating the case management plan on an ongoing basis, adhering to professional practice standards and case management policies. Additionally, the Case Manager will participate in training initiatives and demonstrate a commitment to continuing education to maintain clinical expertise. Sensitivity to culturally diverse situations and clients is essential, as the Case Manager will work with a diverse population, including those with significant educational and socioeconomic barriers impacting their health. This position is designed for individuals who are proactive, organized, and capable of managing multiple tasks in a rapidly changing environment.

Responsibilities

• Establishes a collaborative relationship with clients, families, physicians, and other providers to assess medical history and current health status.

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• Promotes consumerism through education and health advocacy.

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• Assesses member's health status and treatment plan, identifying gaps or barriers to healthcare.

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• Establishes a documented patient-centric case management plan involving all appropriate parties.

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• Implements, coordinates, monitors, and evaluates the case management plan on an ongoing basis.

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• Adheres to professional practice standards and case management policies and procedures.

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• Participates in unit and corporate training initiatives and maintains clinical expertise through continuing education.

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• Demonstrates sensitivity to culturally diverse situations and clients.

Requirements

• Active unrestricted Registered Nurse (RN) license in the United States; Compact RN license is a plus.

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• Two years of full-time equivalent direct clinical care experience.

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• Previous case management experience with the Medicare/Medicaid population, particularly with Special Needs Plans.

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• Knowledge of community resources is helpful.

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• Excellent verbal and written communication and interpersonal skills.

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• Ability to learn new processes and systems quickly.

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• Strong time management and organizational skills.

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• Ability to prioritize work and manage time effectively.

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• Strong research, analytical, and problem-solving skills.

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• Ability to work independently and in a rapidly changing environment.

Nice-to-haves

• CCM certification within three years of hire as a case manager.

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• Experience in medical management and case management in a managed care setting.

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• Knowledge of managed care products and strategies.

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• Strong personal computer skills, including MS Word, Excel, and Outlook.

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• Experience in teamwork, conflict management, and effective decision-making.

Benefits

• Medical, vision, and dental insurance coverage.

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• Well-being and behavioral health programs.

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• 401(k) with company match.

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• Company-paid life insurance.

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• Tuition reimbursement.

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• A minimum of 18 days of paid time off per year.

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• Paid holidays.

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• Annual bonus plan eligibility.

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