Nurse Case Management Lead Analyst_ESSDS (Finance)
Nurse Case Management Lead Analyst (ESSDS) - Accredo
Introduction:
As a Nurse Case Management Lead Analyst,you will be responsible for supporting assigned offices in the review of clinical criteria and submission of prior authorization and appeal requests to work towards coverage for patient medication therapy. The role will additionally follow all department's standard operating procedures. This position requires ability to work at home and flexibility to work any shift within the hours of Monday-Friday, 7:00 am - 7:00 pm CST
Responsibilities/Job Scope:
- Always maintain a professional and ethical behavior as outlined by the Nurse Practice Act and applicable company policies.
- Review and gather clinical documentation required per the health plan's guidelines/criteria for submission of prior authorization and appeal requests.
- Actively collaborate with assigned offices to gather any additional needed documentation that may be required for coverage review requests.
- Document notes within program system to include details outlining review of the clinical documentation that was submitted for the requested medication.
- Resolve inquiries from providers regarding decision outcomes and direction of next steps.
- Establish and maintain solid working relationships with operational stakeholders, including internal cross functional teams.
- Perform other duties and special projects as assigned.
Qualifications:
- Nursing degree, BSN preferred
- Ability to work any shift within the hours of - Monday-Friday, 7:00 am - 7:00 pm CST
- 2+ years experience in a clinical setting with PBM and/or specialty medication industry preferred
- Licensures/Certifications: Unencumbered Registered Nurse licensure in the state of primary residence; Compact nursing license preferred.
- Excellent communication skills; written and oral
- Strong computer skills including Outlook and MS office, and Excel
- Advanced critical thinking and problem-solving skills.
- Ability to work collaboratively within interdepartmental teams to resolve complex issues.
- Ability to adapt to a dynamic working environment and make independent decisions
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 annual salary of 76,600 - 127,600 USD / yearly, 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 Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
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.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
