Hartford - CT Full Time 4 days ago

Work From Home! Start dates are 10/17 or 11/7

The Clinical Reviewer will be responsible for:

All clinical certification activities, which include but are not limited to evaluating telephone, fax or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review as appropriate.

Know and understand complex case specialties and case reviews.

Review clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met.

Maintain current departmental standards related to productivity.

Train in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures.

Prepare program correspondence as needed.

Serve as a resource for members calling for assistance.

Make outbound calls as required.

Refer provider and member complaints, and appeals to appropriate departments.

Maintain patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations.

Provide outstanding customer service ensuring callers receive the highest possible service.

Run and analyze reports to ensure all tasks are completed in a timely fashion and meet regulatory requirements.

Assist team members in departmental chats, by phone and in person.

Act as training assistant when assigned.

Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed.

Performs related duties as required.

Essential Functions:

Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications.

Excellent communication skills both verbal and written;

Excellent problem solving and customer service skills are required.

Must be self directed and highly motivated with an ability to multi-task.

Excellent computer skills.

Must type at least 30 WPM.

Must be able to hear and speak on the phone for an entire shift

Qualifications:

Degree in Nursing required

Current, unrestricted license as an RN or LPN in state of primary residence

Must have at least 1 year of acute care, managed care, ER, ICU experience or 2 years of clinical utilization management experience

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 25 – 37 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.

Cigna 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.

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