The job profile for this position is Case Management Analyst, which is a Band 2 Senior Contributor Career Track Role.

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LPN/LVN Case Management Analyst – Short-Term Case Management (Cigna Medicare Clinical Operations) Work from Home, Anywhere, USA (Compact Nursing License Required)

Job Description Summary

Delivers professional activities in the Case Management job family. Coordinates enrollee care needs across the continuum for assigned members who are medically stable but require primary psychosocial support and acute intermittent medical support. Interviews members and relatives to obtain social history relevant to medical problems and care planning. Assists members with environmental difficulties that interfere with obtaining maximum benefits from medical care. Serves as a liaison between primary care team, members, relatives and appropriate outside agencies. Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial reports/analyses for review. May provide guidance, coaching, and direction to more junior members of the team in Case Management. Requires LPN/LVN.

Job Description

This position works under supervision, prioritizing data from multiple sources to provide quality care and support to the patient and family. The LPN/LVN interacts with all levels of staff in a variety of departments; physicians, patients, families as well as external contacts, such as employees of other healthcare institutions community clinicians and agencies concerning the healthcare of the patient. The focus is always on a positive patient experience.

Essential Duties and Responsibilities:

• Responsible for the effective and sufficient support of all Case Management activities to include review of inpatient and outpatient medical records for appropriateness of case management resources.
• Uses an established set of criteria to evaluates and approve the necessity of case management services rendered.
• Provide notification of decisions in accordance with compliance guidelines.
• 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 CM Department and throughout Clinical Operations 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 management of medical cases
• Proficient knowledge of policies and procedures, Medicare, HIPAA 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
• Other duties as required

Qualifications:

• Current Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN. 
• State Compact LPN License Required
• Minimum 3-5 years clinical experience.
• Experience in managed care setting preferred
• Strong customer orientation 
• Strong organizational, planning, and communication skills
• Working knowledge of insurance industry
• Excellent time management skills, self-starter, and highly motivated
• Ability to multi-task and complete various projects under tight deadlines

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.

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.

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.