Pre-Service Care Coordinator - EviCore - Work at Home

Job Description:

The Registered Nurse or Licensed Practical Nurse responsibilities include but not limited to:

• Perform clinical and operational processes related to utilization review of pre-service and retrospective requests for Post-Acute Care services including but not limited to long term acute care, skilled nursing and inpatient rehab facilities.
• Responsible for reviewing the clinical record using evidenced-based guidelines, accurate and timely documentation and communication with health-care providers and Medical Directors for all assigned patients throughout the utilization review process.
• Assist with the coordination between providers and members.

Minimum Education, Licensure and Professional Certification Requirements:

• Current unrestricted Registered Nurse licensure or Licensed Practical Nurse licensure.
• Associate degree or Bachelor Degree in Nursing preferred; completion of LPN program preferred.
• Multistate license preferred

Minimum Experience Required:

• 2+ years of clinical experience
• 2 + years' experience in utilization management preferred.
• Home health, SNF, and/or rehab experience desired
• Medicare/Medicaid managed care programs preferred
• Position is telephonic/Work at Home.
• Hours: Monday - Friday; 9a-6p Central Time Zone; Position is full-time during core business hours with the ability to work any shift between 7 am and 7 pm CST.
• Availability for weekend rotation, on-call rotation, 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.
• Ability to perform 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 develop 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 the ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint with the ability to type 30 wpm preferred
• 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 27 - 41 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 Group.