***This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.***

The Quality Support Team's mission is to ensure a Customer Strong experience through facilitating the compliance and standards of the medical necessity process for peer reviews through Me to We collaboration with internal matrix partners and facilities. The Case Coordinator role is a fast-paced position that is inclusive of all of the Cigna cultural beliefs and comprises numerous tasks including:

• Complete scheduling of peer reviews for all lines of business (Cigna East, TruCare, CareAllies, Cigna West, QANI, and QANI Legacy) which includes building and verifying template information, making outbound/receiving inbound calls from facility to schedule, coordinating MD calendars, documenting in the case, assigning for follow-up, updating a peer review tracker, and notifying Case Managers


• Provide verbal determination to facility on results of peer reviews


• Complete follow-up on cases after peer review including assisting with alternative level of care authorizations, discharge planning, and making referrals to behavioral specialty case management programs ( Listen to Advocate )


• Utilize workflows efficiently to ensure accurate documentation and adhere to compliance guidelines ( Think it Through )


• Responsible for management of MD Scheduling mailbox


• Work closely with internal matrix partners to ensure legal, Federal, and State Mandates are in compliance, and NCQA and URAC accreditation guidelines are met ( Own It! )


• Proficiently communicate with matrix partners including appeals coordinators, Case Managers, Medical Directors, individual HCP's, and facilities ( Be Bold )


• Provide exceptional customer service ( Customer Strong ), collaborating closely with matrix partners, to ensure each case is completed and effectively communicated to the customer and facility in a timely manner ( Me to We )


• End of month reporting for various data that includes all lines of business


• Additional tasks as assigned

Qualifications:

• Bachelor's degree required


• At least 2 years of experience in behavioral health services setting


• Strong verbal, written, and interpersonal communication skills


• Effective listening and analytical skills


• Extremely detail oriented and proficient organizational skills


• Strong ability to multi-task and exhibit excellent prioritization skills


• Experience working on multiple projects simultaneously under tight deadlines


• Technical knowledge of automated databases, tracking systems, spreadsheet applications


• Ability to manage change effectively and assist in leading others through the change process

WORK SCHEDULE: Mon-Fri 10:30am-7:00pm CST

LOCATIONS: Any Cigna Office or WAH (only if already WAH)

This position is not eligible to be performed in Colorado.

About Evernorth

Evernorth, Cigna Corporation's health services segment, exists to elevate health for all. We're building on our legacy and redefining health care as we know it. Unbiased in how we think, we create without limitation. We partner without constraints, deliver value differently and act in the interest of humanity. Solving across silos, closing gaps in care, and empowering clients, customers, and people everywhere to move onward and upward. When you work with us, you'll be empowered to solve the problems others don't, won't or can't. Join us. 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.