(RN) Utilization Review Nurse(Prior Authorization) California -
Location: Nevada
Description: Cigna is at present looking to employ (RN) Utilization Review Nurse(Prior Authorization) California - right now, this occupation will be placed in Nevada. For complete informations about this occupation opportunity kindly see the descriptions. Job Description
Responsibilities
Utilizes effective communication, courtesy and professionalism in all in! teractions, both internally and externally. Assists and supports customer/account management processes as required.
Provides service delivery on assigned products in a manner consistent with established standard policies/procedures and customer result expectations. Requires performance on such things as:
Work with providers and participants to identify contracted providers for provision of services
Utilize established screening criteria to identify cases which require case management services
Evaluates medical information against criteria, benefit plan, and coverage policies and determines necessity for procedure and refers to Medical Director if criteria is not met
Adheres to quality assurance standards and all utilization management policies and procedures.
Serves as a resource to facilitate understanding of products
Handles some routine complaints; secures supervisory assistance with problem solving and decis! ion making
Advises supervisory staff of any concerns ! or complaints expressed by providers, patients, insured, and customers
Attains established production standards and operational objectives including reviews/transactions completed per day, case documentation and telephone response requirements as established for this level
Performs additional unit duties below as appropriate:
Participate on special projects/customer demonstrations
Support and assist with training and precepting as required
Interface with sales/account managers as appropriate to meet customer’s needs
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Requirements
Qualifications
Minimum Requirements
Current California RN licensure required
Must be unrestricted
Bachelor Degree in Nursing preferred
Maintain active nursing as required by state and company guidelines.
Recent clinical or Utilization Review experience preferred
Preferred Requirements
Computer skills and ty! ping expertise
Clinical experience in acute setting for 3 or more years
Utilization Management experience
Excellent time management, organizational, research, analytical, customer service, communication (verbal and written) and interpersonal skills.
Ability to work in an automated environment
Ability to function as part of a team
Ability to multi-task
Knowledge of Utilization Management and Insurance Industry .
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Wed, 20 Mar 2013 15:28:46 GMT
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