Care Lead Associate – Cigna – Remote

The Cigna Group, Hartford, CT 06152, Openings : 1, Experience : Not Specified
Job Description :
  • This is a remote position that is typically an 8-hour dayshift Monday through Friday.
Assists/collaborates with facilities, MD offices, and/or customers that require specialty drugs to meet an individuals healthcare needs and coordinate delivery of medication. Through communication and available resources, the lead will assist with non-clinical duties such as outreaching/collaborating with MD offices, confirming sites of care have all clinical information needed, enforcing specialty medical injectable reimbursement restriction guidelines as appropriate, complete referrals, authorization entry, medical cost savings details, and limited customer/patient outreach.

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 the caller’s needs and collaborating with the RN for direction and intervention as necessary. Based upon the call type and requests, the Care Coordination Lead 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 communication with the RN Case Manager, as needed, 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 client, physician(s), and other providers to coordinate care.
Assist with enforcement/reinforcement of policies, guidelines, and/or benefit language with facilities, customers, and/or provider offices.
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, which may be done with the RN Case Manager, as appropriate.
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.
Interacts with leadership, Medical Directors and/or Nurse Case Managers as needed for direction and/or denial review.
The Lead interacts with Care Associates, benefit specialists, Pharmacy Service Center, Accredo Specialty Pharmacy and claims staff for claim payment direction to ensure correct interpretation of current and future cost of care.
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.
Any other assigned tasks as deemed necessary to meet business needs.

Minimum Requirements:
High School Diploma

Preferred Requirements
Excellent time management, organizational, research, analytical, and interpersonal skills.
Ability to communicate needs effectively to facilities, 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.
Associate’s degree or higher education.

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 19 – 29 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 Group .

About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: for support. Do not email 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.
Last Date For Apply: 2023-10-11 00:00:00 Job Type : FULL_TIME, Employment Type : FULL_TIMEExpired