Cigna
Cigna Health Care LPN/LVN Case Management Analyst - Precertification (Cigna Medicare Clinical Operations)
This job is now closed
Job Description
- Req#: 23012068
Advantages of Joining Our Team:
- Be part of a healthcare company that advocates for better health through every stage of life
- Guide customers through the healthcare system and empower them to make informed choices for improving their health
- Contribute to driving growth and improving lives
Job Description:
- Collaborate with healthcare providers, members, and business partners to optimize member benefits and promote effective resource use
- Evaluate medical necessity and appropriateness of services, including planned elective services, surgical and diagnostic procedures, durable medical equipment, and out-of-network services
- Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts
- Use established criteria to evaluate and authorize the medical necessity of services
- Coordinate with Medical Directors for services that do not meet criteria or require additional review
Responsibilities:
- Support all Utilization Management activities, including review of inpatient and outpatient medical services
- Provide notification of decisions in accordance with compliance guidelines
- Participate in staff meetings, trainings, and collaborative meetings
- Work with management team to achieve operational objectives and financial goals
- Support teams across UM Department as needed
Qualifications:
- Current licensure as a Licensed Practical Nurse LPN, Licensed Vocational Nurse LVN, or Registered Nurse RN
- Minimum 2-3 years of clinical experience
- Experience in regulated managed care setting preferred
Schedule:
- Friday, Saturday, Sunday, and Monday from 8:30 am to 6:00 pm
Additional Information:
- If working from home, internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload
- The employer has a tobacco-free policy and may not hire tobacco/nicotine users in certain states, unless they enter a qualifying smoking cessation program prior to 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.About the company
Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.
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