26002207 RN QUALITY SPECIALIST

Role Summary

Provides remote, patient-centered case management support and education to assigned patients. The role focuses on relationship building, care coordination, and navigation of insurance and pharmacy protocols to support medication access, adherence, and disease-state education.  

Essential Functions

• Adhere to all program-specific contractual agreements, company policies, quality standards, and compliance requirements.
• Build and maintain therapeutic relationships with assigned patients throughout the duration of the program.
• Deliver patient-centric education regarding treatments, disease states, and prescribed products.
• Manage a designated caseload including scheduled outreach, adherence monitoring, and accurate documentation in program databases.
• Coordinate interactions between patients and internal or external clinical partners as appropriate.
• Customize interactions based on individual patient needs, health literacy, and program requirements.
• Participate in program-specific customer meetings, training sessions, and orientations.
• Demonstrate clinical competency and system proficiency as validated through required assessments.
• Support special projects and additional duties aligned to contract performance and business needs.

Schedule

• Hours: 11:00 a.m. – 8:00 p.m. Eastern Time

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in primary state of residence; compact license required.
• Minimum of two (2) years of RN clinical experience.
• Demonstrated proficiency with Microsoft Office applications and basic database navigation.
• Strong verbal and written communication skills.
• Ability to manage multiple priorities, meet deadlines, and work independently in a remote environment.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN) or active enrollment in a BSN program.
• Case management or care coordination experience.
• Knowledge of pharmacy operations, pharmaceuticals, life sciences, or healthcare business environments.

Core Competencies

• Patient-focused and quality-driven approach to care.
• Collaboration and teamwork across multidisciplinary partners.
• Accountability, ownership, and results orientation.
• Professional judgment and adherence to ethical standards.

                  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 33 - 56 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 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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.     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.