LVN/RN Case Coordinator - Nashville, TN
Location: Nashville Tennessee
Description: Cigna is at present recruited LVN/RN Case Coordinator - Nashville, TN right now, this career will be placed in Tennessee. Further informations about this career opportunity kindly read the description below. Job Description
Responsibilities
Responsible for the effective and sufficient support of all utilization management activities to include prospective/ pre-certification review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies. Evaluates and authorizes the medical necessity of inpatient and outpatient services. Notifies provider of recommended changes in level of care. Evaluates cases for quality of care and documents quality issues. Reviews medical necessi! ty for more complicated or escalated pre-certification service! s. May participate or assist in the planning of team, UM/QM, PCP, IPA, and/or Health Plan meetings, on or off-site. May act as Team Lead. Serves as a subject matter expert on process improvement teams. May serve as trainer for department, new hires, and/or IPA staff. Participates in departmental projects as assigned. .
Requirements
Qualifications
Minimum Requirements: 3 years clinical experience. Current unrestriced TN licensure as a Licensed Practical Nurse (LPN) or as a Registered Nurse (RN). Good critical thinking and organizational skills. Must be self sufficient and adaptable.
Preferred Requirements: Managed care experience. Four years experience in utilization review or managed care. Knowledge of ICD-9 and CPT Coding
Hours are: 7a-4p or 8 a.m.-5 p.m. Hours rotate monthly on this schedule. Mon-Friday with some opportunity for overtime. Full-time, 40 hours per week. .
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If you were eligible! to this career, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Wed, 05 Feb 2014 18:32:33 GMT
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