Complex Case Management Team Lead (Premium) - Evernorth Health Services - Remote at Cigna

The Telephonic Case Manager Team Lead supports clinical case management operations by mentoring team members, promoting quality outcomes, and helping the team deliver a consistent customer experience. This full-time, work-at-home role requires employees to conduct business in a secure, private area of the home where confidential conversations cannot be overheard.

What you’ll do

• Support team performance related to clinical outcomes, total cost of care, stakeholder experience, and operational goals.
• Partner with the Clinical Supervisor to support employee engagement, retention, coaching, and development.
• Train, mentor, and support new and existing team members in partnership with leadership.
• Promote collaboration across clinical disciplines and help identify development opportunities at the individual and team level.
• Guide team members toward evidence-based actions that support quality outcomes and appropriate medical cost management.
• Participate in workgroups, committees, team meetings, and special projects as needed.

Additional responsibilities

In this role, you will also:

• Complete chair-side assessments in Verint to support adherence to standard operating procedures and clinical quality expectations.
• Assist the Clinical Supervisor with audits, including NCQA, calendar, and account-specific audits.
• Support clinical rounds in partnership with Medical Directors.
• Resolve escalated issues referred by internal teams or customers.
• Serve as a clinical case management subject matter expert.
• Support new hire orientation in partnership with Workforce Development.
• Assist with day-to-day team operations, including team meetings, coaching support, call-off support, and monitoring team communication spaces.
• Maintain a case management workload equal to approximately 50% of the team average, including customer-facing and medical management cases.

Required qualifications

• Active, unrestricted RN license in good standing in state of residence
• Clinical nursing experience with demonstrated ability to apply clinical judgment in a case management setting.
• Experience in complex case management.
• Ability to provide coaching, feedback, and mentoring to team members.
• Ability to work from home in a secure, private workspace that supports confidential conversations.

Preferred qualifications

• Strong administrative, computer, and software application skills.
• Effective interpersonal, written, and verbal communication skills.
• Ability to work collaboratively in a team environment.
• Strong clinical acumen, sound decision-making skills, and ability to analyze quantitative and qualitative data.
• Demonstrated ability to prioritize work, manage time, and delegate when appropriate.
• Ability to resolve internal and external concerns in a professional, customer-focused manner.
• Experience communicating directly with customers by phone and in writing; telephonic coaching or counseling experience is helpful.

Equal Opportunity Statement

The Cigna Group is committed to equal employment opportunity and provides consideration for employment without regard to race, color, age, disability, sex, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, citizenship status, or any other characteristic protected by applicable law.

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 and paid holidays. For more details on our employee benefits programs, click here.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com 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.