Job description
Case Management Senior Analyst (RN Case Manager)
As a Case Management Senior Analyst, you will guide complex cases across the full care journey. You will connect members, providers, and plan partners to the right care at the right time—improving outcomes, reducing avoidable costs, and making the experience feel human. If you like solving tough problems with compassion and data, you’ll thrive here.
Responsibilities
Lead complex case planning from intake through resolution, aligning clinical needs, benefits, and community resources to support safe, timely care.
Partner with members, families, providers, and internal teams to set clear short- and long-term goals and track progress toward better health outcomes.
Reduce fragmentation by coordinating services across settings (inpatient, rehab, outpatient, preventive) and adjusting plans as needs change.
Use utilization review and strong documentation to ensure services meet criteria, benefits are maximized, and care is both effective and cost-aware.
Coach members on their condition, treatment options, and next steps so they can make informed choices and stay engaged in their care.
Escalate quality-of-care or complex clinical questions to the Medical Director and help drive timely, well-informed decisions.
Strengthen team performance by supporting quality reviews, leading risk meetings as needed, and mentoring new team members.
Qualifications
Required
Active RN license (state-appropriate) with an associate degree in nursing (ASN) or higher. Compact license required if live in a Nursing Compact state.
Minimum 3 years of recent clinical practice experience in Oncology, Behavioral Health, In-patient, Critical Care, or Med/Surg.
Strong skills in care planning, care coordination, and patient advocacy across the continuum of care.
Clear, respectful communication (written and verbal) with members, families, providers, and business partners.
Comfort using a PC and common tools (Windows and Word) and ability to learn new systems as they change.
Preferred
Previous case management experience in a health plan, employer, or clinical setting.
Certified Case Manager (CCM) credential (or ability to obtain within 12 months of hire).
Experience interpreting benefit plan documents and applying guidelines to real member situations.
Quality improvement or training/mentorship experience (QA programs, risk reviews, onboarding).
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 57,600 - 96,000 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.
At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.