What are the responsibilities and job description for the Utilization Review Analyst position at Cigna?
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
Delivers specific delegated tasks assigned by a supervisor in the Utilization Management job family. Determines whether services provided to plan members were actually medically necessary. Develops and maintains knowledge of provider organization review procedures. Maintains reporting system for Utilization Review. Completes day-to-day Utilization Review tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. Requires a LPN or RN.
Are you a nurse with a passion for ensuring access to evidence based medicine? Do you have a desire to pivot your nursing career in more of an administrative direction? Our Preservice UM Nurses are responsible for looking at individual requests for Prior Authorization. You will have the chance to use critical thinking and attention to detail, while leaning on your clinical knowledge and medical training to review clinical information submitted by providers to appropriate criteria and standards regarding placement in Long Term Care Facilities, Inpatient Rehab or Skilled Nursing Facilities, based on medical necessity.
When requests for authorization come through the phone, web or fax queue, you will review and compare against established clinical guidelines, and authorize services if appropriate, or refer requests for expert review by our board certified physicians.
Full, paid training provided in Utilization management, clinical certification, URAC and NCQA principles, policies and procedures.
Some of the day to day duties will include:
Maintain productivity standards with speed and accuracy to ensure we keep our commitments to our patients.
Prepares program correspondence as needed.
Serves as a resource for members calling for assistance.
Makes outbound calls as required.
Refers provider and member complaints, and appeals to appropriate departments.
Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations.
Provides outstanding customer service ensuring callers receive the highest possible service.
Runs and analyzes report in MS Excel ensuring all tasks are completed in a timely fashion and meet regulatory requirements.
Assists team members in departmental chats, by phone, and in person.
Acts as a training assistant when assigned.
Assist team members with questions, participates in team meetings.
Can be assigned to projects to support the department as needed.
What you will need to be successful:
Current, unrestricted license as an RN or LPN in state of a primary residence or appropriate compact state.
At least 1 year of acute care, managed care, ER or ICU experience.
At least 1 year of experience with Utilization Management in either provider or Managed Care setting
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 and typing skills required
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
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.
Delivers specific delegated tasks assigned by a supervisor in the Utilization Management job family. Determines whether services provided to plan members were actually medically necessary. Develops and maintains knowledge of provider organization review procedures. Maintains reporting system for Utilization Review. Completes day-to-day Utilization Review tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. Requires a LPN or RN.
Are you a nurse with a passion for ensuring access to evidence based medicine? Do you have a desire to pivot your nursing career in more of an administrative direction? Our Preservice UM Nurses are responsible for looking at individual requests for Prior Authorization. You will have the chance to use critical thinking and attention to detail, while leaning on your clinical knowledge and medical training to review clinical information submitted by providers to appropriate criteria and standards regarding placement in Long Term Care Facilities, Inpatient Rehab or Skilled Nursing Facilities, based on medical necessity.
When requests for authorization come through the phone, web or fax queue, you will review and compare against established clinical guidelines, and authorize services if appropriate, or refer requests for expert review by our board certified physicians.
Full, paid training provided in Utilization management, clinical certification, URAC and NCQA principles, policies and procedures.
Some of the day to day duties will include:
Maintain productivity standards with speed and accuracy to ensure we keep our commitments to our patients.
Prepares program correspondence as needed.
Serves as a resource for members calling for assistance.
Makes outbound calls as required.
Refers provider and member complaints, and appeals to appropriate departments.
Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations.
Provides outstanding customer service ensuring callers receive the highest possible service.
Runs and analyzes report in MS Excel ensuring all tasks are completed in a timely fashion and meet regulatory requirements.
Assists team members in departmental chats, by phone, and in person.
Acts as a training assistant when assigned.
Assist team members with questions, participates in team meetings.
Can be assigned to projects to support the department as needed.
What you will need to be successful:
Current, unrestricted license as an RN or LPN in state of a primary residence or appropriate compact state.
At least 1 year of acute care, managed care, ER or ICU experience.
At least 1 year of experience with Utilization Management in either provider or Managed Care setting
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 and typing skills required
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
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.
Salary : $25 - $37
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