DME Care Coordinator - eviCore - Telephonic at Cigna

Posted in General Business 16 days ago.

Type: Full-Time
Location: Bloomfield, Connecticut





Job Description:

Job Description

The Registered Nurse or Licensed Practical Nurse will be responsible for performing Prior Authorization Reviews for our Customers of Durable Medical Equipment (DME) and Sleep Services. The Registered Nurse or Licensed Practical Nurse will review Clinical Documentation provided by Physicians/ Providers/ Suppliers to established company protocols and clinical guidelines and then Documenting decisions utilizing criteria that is based on established Evidence Based Practice Guidelines. Responsibilities include:


  • Provide excellent customer service by handling confidential and sensitive information with discretion during collaboration and communication with external and internal contacts ensuring the development of strong relationships with these stakeholders while clearly representing business needs as well as business determinations.

  • Possess a clear, straightforward and reasonably concise style in writing documents, paying attention to detail including spelling and grammar while effectively transferring thoughts, information and ideas in a timely and concise manner.

Minimum Education and Licensure :


  • Completion of LPN program or Associate Degree in Nursing Required

  • Current unrestricted Registered Nurse or Licensed Practical Nurse license in state of residence. Multistate license status preferred.

Minimum Experience required


  • Minimum 5 years clinical experience with at least 3 years managed care experience

  • 2 - 4 years experience in utilization management required

  • Home health, SNF, DME, and/orrehab experience desired

  • Medicare/Medicaid managed care programs preferred

Status


  • Position is remote

  • Position is full-time. Hours are Monday - Friday; starting anywhere from 9am-11am CST time zone plus mandatory on call responsibility after business hours. Will require weekend and holiday rotation.

  • Ability to sit at a desk 50% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day; walking and standing

  • Dependable and reliable work schedule is essential

Required Skills:


  • Time-management : Ability to effectively manage one's time and resources to ensure that work is completed efficiently Excellent organizational skills

  • Communication : Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership

  • Critical-Thinking/Decision-making : Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities

  • Autonomy : Ability to work independently with little to no supervision

  • Proficient in computer literacy skills with ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint

  • Experience using videoconferencing systems such as WebEx

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.





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