The Cigna Group

Compensation

Full Description

The 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 you, we encourage you to apply! Our people make all the difference in our success. The Case Management Analyst (LPN) will: Assists/collaborates with RN Case Manager on customers that require specialty drug redirection to meet an individual's healthcare needs. Through communication and available resources, the LPN will complete administrative medical duties such as outreaching/collaborating with MD offices, confirming sites of care have all clinical information needed, authorization entry, medical cost savings details, and limited customer/patient outreach. Using available internal resources and through collaboration with Medical Directors, the LPN will assist in network adequacy reviews for medical specialty drugs. This position services calls in a warm and empathetic manner as the calls can be sensitive in nature. Problem solving skills are critical to success within the role along with intelligent judgment of assessing the caller’s needs and collaborating with the RN for direction and intervention as necessary. Based upon the call type and requests, the LPN should be able to use customer service skills, knowledge of the specialty pharmacy processes and Cigna training to effectively address caller’s needs and/or issues/concerns. Incumbents will utilize telephonic communication, web based documentation and resources, and internal materials to assist in achieving successful redirection and coordination. Collaboration and regular communication with the customer, prescriber, and alternate site of care is critical to ensure timely coordination of redirection and customer needs. Time management skills are crucial. Major Job Responsibilities and Required Results: Establishes a collaborative relationship with the customer, physician(s), and other providers to coordinate care. Documents findings in a clear concise manner. Acts as a liaison with the account, client/family, physician(s), internal and external matrix partners, and facilities/agencies. Maintains accurate record (system) of interventions including cost/benefit analysis, savings, and data collection. Adheres to quality assurance standards and all case management policy and procedures. Meets case volumes and turn around times per policy. Interacts with Medical Directors as needed in collaboration with RN Case Manager. The LPN interacts with Care Associates, benefit specialists, Pharmacy Service Center, Accredo Specialty Pharmacy and claims staff for claim payment directions to ensure correct interpretation of current and future cost of care. Assists Sales Account Executive in communicating status and/or resolving issues for service center-based customers, as assigned. Participates on committees, task forces and other company projects, as assigned. Supports training initiatives or audits of case files, as assigned. Demonstrates sensitivity to culturally diverse situations, clients and customers. Ensures the member’s privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards. Access the various Cigna systems to obtain requested information such as eligibility, benefits, demographic information, discharge and clinical information, available customer programs. Ensures complete an thorough research and documentation in network adequacy reviews for medical specialty drugs. Any other assigned tasks as deemed necessary to meet business needs. Minimum Requirements: Graduate of approved LPN/LVN program An unrestricted Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN) license in state of primary residence. Compact License preferred. Minimum of 2 years LPN experience. Hours: Monday - Friday; 8:00 am to 4:30 pm in candidate's time zone. Preferred Requirements: Excellent time management, organizational, research, analytical, and interpersonal skills. Ability to communicate needs effectively to RN Case Manager, physicians’ offices, and interdisciplinary team members. Ability to meet deadlines, promote team concepts, manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments. Ability to adapt to new workflows and tasks quickly. Knowledge of the insurance industry and knowledge of claims processing and specialty pharmacy. Effective listening and organizational skills. Ability to manage multiple tasks, setting priorities where needed. Ability to work independently, problem solve, and function without constant supervision. Prior experience in managed care/healthcare environment ideal. Excellent typing/computer skills with the ability to learn new computer software systems. Strong telephonic communication skills. Working knowledge of Cigna prior authorization and medical management systems 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 24 - 36 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. 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.