Case Management Lead Analyst

Company: Cigna Health and Life Insurance Company
Location: Madrid
Posted on: February 25, 2021

Job Description:

Under the general supervision of the Care Management Sr. Manager, the Global Care Manager Lead Analyst will provide telephonic care management and utilization review to customers outside the United States to help them address and coordinate their medical needs. Major responsibilities and desired results:

• Manages an active caseload of care management cases by providing Information, navigation and coordination to customers in our global client base, outside of the United States.
• Assesses member's health status and treatment plan and identifies any gaps or barriers to healthcare.
• Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc.)
• Identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved
• Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure
• Monitors all inpatient care provided to customers in under the supervision of physicians regarding a treatment plan, members' discharge plans and available covered services
• Ensures that the Medical Director will review any authorization request that does not meet criteria for medical appropriateness, and notifies the appropriate hospital staff with the Notification of Potential Denial.
• Reviews requests for services that require pre-certification, such as treatment by non-participating providers, hospitalization, certain outpatient procedures and surgery, as well as outpatient therapy and rehabilitation programs.
• Maintains accurate record of care management interventions including cost/benefit analysis, savings, and data collection.
• Delivers claim review services when member is in active care management as appropriate
• Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions Required:
  • Foreign Medical Graduate, License Practical Nurse, Registered Nurse.
  • Previous case management, utilization management, claims review and cost containment services experience
  • English and a second of the following languages required: French, German, Italian, Arabic, Japanese and /or Portuguese medical terminology
  • Ability to function under a stressful environment About Cigna Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram. 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: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response. Posted 30+ Days Ago Full time 20021971 About Us Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

Keywords: Cigna Health and Life Insurance Company, Des Moines , Case Management Lead Analyst, Professions , Madrid, Iowa