Performs utilization management duties for Cigna-Medicare members following national and state clinical guidelines for inpatient and outpatient Medicare covered services.Participates in the discharge planning process and identifies appropriate resources both internal and external required for a successful transition of care to an alternative setting.

Job Description:

Responsible for the effective and sufficient support of all behavioral utilization activities for several markets according to policies and procedures. Will focus on utilization management of Medicare covered Behavioral Health requests. Refers cases to the Medical Director as appropriate. Evaluates and refers cases to quality of care, disease management, and case management programs as needed. Assists with discharge planning. Maintains strong working relationship with internal and external customers. Professionally communicates information as needed or required. Documents information into the clinical management system. Supports the Cigna-Medicare Behavioral Health Unit providing data and identifying improvement opportunities.

Minimum Requirements: Current licensure as a Registered Nurse (RN) or Licensed Mental Health Practitioner (LAPSW, LCSW, LPC or LMFT). At least three years clinical experience required and at least two years in utilization review preferred. Knowledge of ICD-10 and CPT coding guidelines. Familiarity in appropriately applying Level of Care Guidelines, including MCG Criteria, for utilization review.

*Must be able to work 1-2 weekend days per month*

This position is not eligible to be performed in Colorado.

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.