Case Management Senior Analyst - Allegiance - Work at Home

The Cigna Group

1d•Remote

About The Position

The Case Management Senior Analyst guides complex cases across the full care journey, connecting members, providers, and plan partners to the right care at the right time. This role aims to improve outcomes, reduce avoidable costs, and provide a human experience. The ideal candidate enjoys solving tough problems with compassion and data.

Requirements

Active RN license (state-appropriate) with an associate degree in nursing (ASN) or higher. Compact license required.
Minimum 3 years of recent clinical practice experience.
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.
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload if working at home occasionally or permanently.

Nice To Haves

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).

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.