Job Description
The Quality Support Team's mission is to maintain a strong stakeholder experience by scheduling peer reviews within compliance timeframes. The Care Coordinator role is a fast-paced position that is inclusive of all of the Evernorth cultural beliefs and comprises numerous tasks including:
Responsibilities: - Complete scheduling of peer reviews for all lines of business (CAMS, TruCare, and CareAllies) which includes building and verifying template information, making outbound/receiving inbound calls from facilities and providers to schedule reviews, coordinating MD/PHD calendars, documenting in the case, assigning for follow-up, and notifying Care Managers
- Provide verbal determination to facilities and providers on results of peer reviews
- Complete follow-up on cases after peer review including: creating alternative level of care authorizations, discharge planning, and appeal requests
- Utilize workflows efficiently to ensure accurate documentation and adhere to compliance guidelines
- Responsible for the management of MD Scheduling mailbox
- Work closely with internal matrix partners to ensure legal, federal, and state mandates are in compliance, and NCQA and URAC accreditation guidelines are met
- Proficiently communicate with matrix partners, including appeals coordinators, case managers, medical directors, individual HCP's, and facilities
- Provide exceptional customer service, collaborating closely with matrix partners, to ensure each case is completed and effectively communicated to the customer and facility in a timely manner
- Additional tasks as assigned
Qualifications - Bachelor's degree required
- At least 2 years of experience in a behavioral health services setting
- Strong verbal, written, and interpersonal communication skills
- Effective listening and analytical skills
- Extremely detail-oriented and proficient organizational skills
- Strong ability to switch tasks and exhibit excellent prioritization skills
- Experience working on multiple projects simultaneously under tight deadlines
- Technical knowledge of automated databases, tracking systems, and spreadsheet applications
- Ability to manage change effectively and assist in leading others through the change process
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 24 - 36 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 .
About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Job Tags
Hourly pay, Holiday work, Permanent employment, Local area, Work from home,