POSITION SUMMARY

The Nurse Clinician is responsible for reviewing escalated clinical criteria reviews for providers, members and patient client advocates within the Prior Authorization/Utilization Management department. Identify and track trends for analytics reporting to ensure clinical criteria program integrity. Maintain a professional and ethical behavior at all times as outlined by the Nurse Practice Act and applicable company policies.

JOB DUTIES

• Conduct criteria reviews for commercial payers, Medicare, and Medicaid
  
  
• Provide prior authorization assistance, and denial appeal assistance
  
  
• Prepare and write medical necessity appeal letters for claim denials for commercial and government payers.
  
  
• Support all aspects of Patient Access and Revenue Cycle Management (PARCM), including clearance and reimbursement for multiple Therapeutic Resource Centers.
  
  

QUALIFICATIONS

• Active, unencumbered Registered Nurse (RN) license in Pennsylvania
  
  
• High School Diploma or GED, plus 8+ years of relevant RN experience; or
  
  
• 5+ years of relevant RN experience with an ASN degree; or
  
  
• 2+ years of relevant RN experience with a BSN degree
  
  
• Case management experience preferred
  
  
• 5+ years of experience is preferred in prior authorization or utilization review and appeals
  
  
• Demonstrated proficiency with Microsoft Office software; basic database navigation
  
  
• Ability to multitask in both PC/Phone related tasks
  
  
• Ability to build strong working relationships with colleagues and customers
  
  
• Strong time management skills and the ability to prioritize work and meet deadlines
  
  
• Excellent verbal and written communication skills
  
  
• Ability to work Monday-Friday, 8am-5pm, Eastern time
  
  
• Adequate home internet access will be required in this role
  
  

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.