Senior Clinical Reviewer, RN UM
Description:
Manages/Coordinates an active caseload of inpatient case management cases for Cigna.
Uses clinical knowledge to assess inpatient admission level of care and treatment plans.
Establishes patient centric goals and interventions.
Interfaces with facility, member, family, and healthcare team members.
Balances business needs with patient advocacy.
Plans, implements, and evaluates health care services in conjunction with the physician treatment plan.
Handles complex, high acuity cases and performs various reviews for care and discharges.
Develops structured working relationships with key partners for regular communication.
Acts as a resource and liaison between various parties involved in patient care.
Identifies and builds relationships with community and government resources.
Requirements:
Active unrestricted Registered Nurse (RN) license in California.
Bachelors degree preferred.
2 - 3 years clinical experience in inpatient or managed care setting.
Demonstrated ability to anticipate, plan, coordinate and organize.
Knowledge of community, state and federal resources.
Valid drivers license, proof of insurance, good driving record, and reliable transportation.
Strong skills in teamwork, negotiation, conflict management, problem solving, and effective decision making.
Experience in medical management and case management in a managed care setting or hospital is highly desirable.
Ability to assess complex issues, recommend changes and resolve problems.
Strong computer knowledge and abilities.
Knowledge of managed care products and strategies.
Ability to work within changing business environment and balance business needs with patient advocacy.
Experience managing multiple projects in a fast paced matrix driven environment.
Benefits:
Comprehensive range of health-related benefits, including medical, vision, dental.
Well-being and behavioral health programs.
401(k) with company match.
Company paid life insurance.
Tuition reimbursement.
Minimum of 18 days of paid time off per year.
Paid holidays.
Apply Now
Manages/Coordinates an active caseload of inpatient case management cases for Cigna.
Uses clinical knowledge to assess inpatient admission level of care and treatment plans.
Establishes patient centric goals and interventions.
Interfaces with facility, member, family, and healthcare team members.
Balances business needs with patient advocacy.
Plans, implements, and evaluates health care services in conjunction with the physician treatment plan.
Handles complex, high acuity cases and performs various reviews for care and discharges.
Develops structured working relationships with key partners for regular communication.
Acts as a resource and liaison between various parties involved in patient care.
Identifies and builds relationships with community and government resources.
Requirements:
Active unrestricted Registered Nurse (RN) license in California.
Bachelors degree preferred.
2 - 3 years clinical experience in inpatient or managed care setting.
Demonstrated ability to anticipate, plan, coordinate and organize.
Knowledge of community, state and federal resources.
Valid drivers license, proof of insurance, good driving record, and reliable transportation.
Strong skills in teamwork, negotiation, conflict management, problem solving, and effective decision making.
Experience in medical management and case management in a managed care setting or hospital is highly desirable.
Ability to assess complex issues, recommend changes and resolve problems.
Strong computer knowledge and abilities.
Knowledge of managed care products and strategies.
Ability to work within changing business environment and balance business needs with patient advocacy.
Experience managing multiple projects in a fast paced matrix driven environment.
Benefits:
Comprehensive range of health-related benefits, including medical, vision, dental.
Well-being and behavioral health programs.
401(k) with company match.
Company paid life insurance.
Tuition reimbursement.
Minimum of 18 days of paid time off per year.
Paid holidays.
Apply Now