Utilization Review Nurse (Acute Care Case Manager)-HealthSpring
Location: Mobile Alabama
Description: Cigna is currently interviewing Utilization Review Nurse (Acute Care Case Manager)-HealthSpring right now, this career will be placed in Alabama. Further informations about this career opportunity kindly read the description below. Job Description
Role Summary
Responsible for responding to an authorization request by obtaining clinical info! rmation, reviewing the clinical provided, and meeting evidence-based criteria. Responsible for preparing for medical director review when criteria is not met. Responsible for documenting required information in the UM documentation system. Responsible for researching other documentation systems as needed. Responsible for keeping the service coordinator apprised of member status upon admission and discharge. 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. .
Responsibilities
Responsible for the effective and sufficient support of all utilization activities according to policies and procedures. Refers cases to the Medical Director as appropriate. Evaluates and refers cases to the quality of care and chronic case improvement programs as needed. Assists with discharge planning. Maintains strong working relationship with internal! and external customers and professionally communicates inform! ation as needed or required. Documents information into the computer system. Provides leadership to other team members. Serves as a preceptor for new employees.. Participates in process improvement teams and serves as a subject matter expert in developing and implementing process changes. Compliant with turnaround times and maintains unit goals. .
Requirements
Qualifications
Requirements : Must have current unrestricted licensure as a Registered Nurse (RN) for the state of Alabama . At least five years clinical experience with at least three years in utilization review. Knowledge of ICD-9 and CPT coding guidelines and evidence-based criteria to establish medical necessity.
Preferred Requirements: - Managed care experience .
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 06 Jun 2013 14:28:09 GMT
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