Nurse Case Management Lead Analyst

2 days ago

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The Cigna Group

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10,000+

Description

• Review escalated clinical criteria for providers, members, and patient client advocates • Identify and track trends for analytics reporting • Conduct criteria reviews for commercial payers, Medicare, and Medicaid • Provide prior authorization and denial appeal assistance • Prepare medical necessity appeal letters for claim denials • Support Patient Access and Revenue Cycle Management

Requirements

• Active, unencumbered Registered Nurse (RN) license in Pennsylvania • High School Diploma or GED, plus 8+ years of relevant RN experience; or 5+ years with ASN; or 2+ years with BSN • Case management experience preferred • 5+ years in prior authorization or utilization review and appeals preferred • Proficiency with Microsoft Office • Ability to multitask PC/Phone related tasks • Strong working relationships with colleagues and customers • Strong time management skills and ability to prioritize • Excellent verbal and written communication skills • Monday-Friday, 8am-5pm Eastern time • Adequate home internet access required

Benefits

• Comprehensive health-related benefits including medical, vision, dental • Well-being and behavioral health programs • 401(k) with company match • Company paid life insurance • Tuition reimbursement • Minimum of 18 days paid time off per year • Paid holidays