The job profile for this position is Case Management Lead Representative, which is a Band 2 Professional Career Track Role.
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Case Management Lead Representative
As Part of Evernorth, CarePathRx, our work helps patients get the care and support they need. As a Case Management Lead Representative, you will serve as a senior team member and subject matter expert for patient care coordination workflows. You will help teammates navigate complex cases, answer process questions, support escalations, and keep daily work moving with accuracy and care. This role is a great fit for an experienced healthcare professional who enjoys sharing knowledge, solving problems, and strengthening the team through collaboration and continuous improvement.
Hours/Schedule: Sunday -Thursday (Sunday- 9am-5pm EST, Monday-Thursday-10am-6:30pm EST)
Responsibilities
Serve as a Senior Team Resource and Subject Matter Expert
• Provide day-to-day guidance to teammates on processes, systems, patient referrals, and care coordination steps.
• Support complex patient cases and operational questions by helping identify next steps and timely solutions.
• Assist with partner inquiries and escalations in close coordination with the supervisor or leader.
• Share best practices that improve consistency, quality, and confidence across the team.
Support Patient and Partner Outcomes
• Participate in partner huddles and team discussions focused on referrals, patient status, and workflow priorities.
• Help monitor patient referral activity and follow up on items that may affect access to care.
• Step in to support patient cases, calls, and workflow tasks during high-volume periods or team absences.
• Promote clear, compassionate communication that supports a positive patient and partner experience.
Coach, Train, and Share Knowledge
• Assist with onboarding and training new team members through job shadowing, screen sharing, and process education.
• Provide peer coaching and practical guidance to help teammates build skill, accuracy, and confidence.
• Model a collaborative, growth-minded approach by encouraging questions, learning, and continuous improvement.
Contribute to Operational Excellence
• Monitor team communication channels and respond to questions as a knowledgeable resource during the workday.
• Share updates, process changes, reminders, and key information through team chats or emails.
• Identify opportunities to improve workflows, reduce barriers, and strengthen service delivery.
• Maintain readiness to support coverage across shifts, including weekends or holidays when business needs require it.
Qualifications
Required Qualifications
• High School Diploma or GED.
• Minimum 2 years of experience in patient care coordination, case management support, healthcare operations, or a related healthcare or pharmacy setting.
• Experience serving as a senior resource, mentor, trainer, peer coach, or subject matter expert for team members.
• Strong communication, organization, and problem-solving skills.
• Proficiency with Microsoft Office applications and patient care coordination systems.
• Ability to manage multiple priorities while maintaining accuracy, professionalism, and attention to detail.
Preferred Qualifications
• Experience processing referrals and reviewing patient insurance benefits.
• Experience communicating patient financial responsibility and coverage information.
• Experience in specialty pharmacy, infusion therapy, home infusion, or related healthcare services.
• Experience supporting process improvement, workflow updates, or operational initiatives.
• Experience helping train, onboard, or coach team members in a healthcare environment.
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.
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.
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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.