Org Marketing Statement .
At CIGNA, we are committed to providing our customers with employee benefits, expertise and services that improve the health, well-being and productivity of their employees. CIGNA's people are the key to our success in a changing and increasingly competitive marketplace. The collective skills, behaviors and work experiences of all CIGNA employees enable us to make a real difference in the lives of our members. We seek the most talented and creative minds in the industry to develop innovative solutions our customers value and consumers expect. .
Major Duties .
Please Note: This role must be based in Houston, Texas and is a Work At Home position.
- Develops and defines a structured working relationship with key partners in assigned inpatient facilities to support regular, effective communication and live exchange of information in compliance with all Federal/ State/ Facility Contract and internal CIGNA requirements.
- Retrieves active daily census each morning and prioritizes cases for review.
- Accesses the approved CIGNA guideline for each inpatient review, and directs the communication with the facility to elicit clinical information as required in the guideline. Limits the retrieval of protected health information to that which is required by the guideline or necessary to discharge planning.
- Identifies all cases appropriate for short term case mgmt interventions , initiates and discusses options for discharge planning with the facility, provider, vendor, member and/ or family on the day of identification, implements plans as appropriate and documents all successful interactions in the case mgmt section of the medical mgmt system for tracking of short term case management activities and outcomes related to those actions.
- Provides or refers to short term case management, post discharge outreach calls on those members who have been successfully discharged as part of a short term case management / discharge planning activity
- Reviews level of care on all inpatient admissions and validates approved level of care according to the member¿s clinical status, with the facility to assure consistency of approved level with the level of care the facility will use for billng.
- Applies knowledge of medical management and Personal Health Solutions as demonstrated through a proactive focus on discharge planning , and identification of any obstacles to discharge with every review.
- Documents all clinical information, discharge plans, level of care changes. Validates any change in level of care consistent with contract and state requirements .
- Identifies new referrals for complex or catastrophic case management and coordinates ongoing CSR review process with the Case Manager to assure a timely discharge, and accurate
- Identify and elevate potential quality of care issues to Quality for follow-up.
- Take actions necessary to prevent and/or reduce overuse, misuse, underuse of services and reducing variations from evidence based medicine.
- Participate in special projects.
- Participate in customer visits and audits .
Qualifications .
- R.N. required, BS preferred with active, unrestricted license. Minimum of 3 years clinical experience.
- Previous experience working with treatment teams to meet the health objectives of participants.
- Previous Utilization Management experience preferred
- Demonstrated ability to anticipate, plan, coordinate and organize.
- Ability to collaborate with treatment teams to meet the healthcare needs of participants.
- Computer skills, including keyboarding required.
- Demonstrated negotiation skills.
- Excellent communication skills.
- Knowledge of community, state and federal resources.
- Knowledge of ICD-9 and CPT-4, HCPCS coding methodologies .
Pay Benefits Work Schedule .
CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development. .
How To Apply .
We encourage you to complete all questions on the candidate profile if you wish to be considered for this opportunity. .
EEO Statement .
CIGNA is an Equal Opportunity Employer .
Return to Previous Page .
Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 07/01/2008
System Time: 05:48:11
Document Name(40): (RN)- Inpatient Case Manager
Source: Indeed - USA
SearchTerms: "work at home" "work from home"
URL(80): http://www.indeed.com/rc/clk?cd=4SCbxM-PrpWjaVdaOd4YwhFWp3iAAGtdwBaPzENdZL5WK3cn
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