Senior Clinical Reviewer, RN UM

Description:
? Manages/Coordinates an active caseload of inpatient case management cases for Cigna.
? Uses clinical knowledge to assess inpatient admission level of care and treatment plans.
? Establishes patient centric goals and interventions.
? Interfaces with facility, member, family, and healthcare team members.
? Balances business needs with patient advocacy.
? Plans, implements, and evaluates health care services in conjunction with the physician treatment plan.
? Handles complex, high acuity cases and performs various reviews for care and discharges.
? Develops structured working relationships with key partners for regular communication.
? Acts as a resource and liaison between various parties involved in patient care.
? Identifies and builds relationships with community and government resources.

Requirements: ? Active unrestricted Registered Nurse (RN) license in California. ? Bachelors degree preferred. ? 2 - 3 years clinical experience in inpatient or managed care setting. ? Demonstrated ability to anticipate, plan, coordinate and organize. ? Knowledge of community, state and federal resources. ? Valid driver?s license, proof of insurance, good driving record, and reliable transportation. ? Strong skills in teamwork, negotiation, conflict management, problem solving, and effective decision making. ? Experience in medical management and case management in a managed care setting or hospital is highly desirable. ? Ability to assess complex issues, recommend changes and resolve problems. ? Strong computer knowledge and abilities. ? Knowledge of managed care products and strategies. ? Ability to work within changing business environment and balance business needs with patient advocacy. ? Experience managing multiple projects in a fast paced matrix driven environment.

Benefits:
? Comprehensive range of health-related benefits, including medical, vision, dental.
? Well-being and behavioral health programs.
? 401(k) with company match.
? Company paid life insurance.
? Tuition reimbursement.
? Minimum of 18 days of paid time off per year.
? Paid holidays.

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