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

Shift: 8:30 a.m.-5:00 p.m. or 9:00 a.m.-5:30p.m. EST

Telephonic Complex Case Manager Team Lead – Work at Home

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.