Cigna RN Utilization Review Nurse/Acute Care - Huntsville, AL (Onsite) in Huntsville, Alabama
Ensuresthe member is at the appropriate level of care, in the appropriate setting, atthe appropriate time through thorough utilization review. Utilizesevidence-based guidelines (Interqual) and collaborates with hospital casemanagers, social workers, Primary Care Physicians, attending physicians,internal team and Cigna- HealthSpring medical directors on a daily basis. Manages all transitions of care related to ahospital stay through patient interviews, effective planning, and collaboration with facility personnel andCigna-HealthSpring teams to prevent unplanned transitions and readmissionsthrough proven interventions. Knowledgeable about member benefits and assistsmember to maximize their individual benefit plan. Facilitates authorizationsfor post-acute care services or medications. Reviews cases for quality of care concerns.
Maintainsstrong working relationship with internal and external customers and communicatesprofessionally. Documents authorizations and case management activities insoftware applications. Assumes leadership role in POD/IPA related meetings andshares knowledge and information. Interacts with local Network Administrator orPOD/IPA medical director and physicians. Participates in process improvementactivities and all STAR-related initiatives. May serve as a preceptor for newemployees.
Minimum Requirements: Current state licensure as a Registered Nurse (RN), ASN. At least 5 years acute care clinical experience. Preferred Requirements: BSN, Utilization review experience, knowledge of ICD and CPT coding, McKesson Interqual Criteria, managed care experience.
Primary Location: Huntsville-Alabama
Work Locations: 3501 Memorial Parkway SW Huntsville 35801
Job: Med Mgt--Utilization Mgmt
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 50 % of the Time
Job Posting: Dec 7, 2018, 4:37:22 PM
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com