(RN) Nurse Case Manager/(Bravo Health)-Baltimore, MD
Location: Baltimore Maryland
Description: Cigna is presently looking of (RN) Nurse Case Manager/(Bravo Health)-Baltimore, MD right now, this occupation will be placed in Maryland. Further informations about this occupation opportunity kindly read the description below. Job Description
Responsibilities
Collecting, analyzing, and evaluating clinical documentation received using established ! criteria to determine appropriateness of clinical decisions; Meet/exceed service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, Abandonment Rate);
Adherence to regulatory and departmental timeframes for review of requests received;
Collaborates with the Medical Director to identify utilization trends and generation of monthly written reports;
Process approval and adverse clinical determination correspondence for members, contracted and non-contracted providers;
Initiate the letter of agreement process, working with Network Management to ensure Service Level Agreements are completed in a timely manner when applicable;
Proficient knowledge of Health Services policies and procedures, Medicare, HIPPA and NCQA standards;
Professional demeanor and the ability to work effectively within a team or independently;
Flexible with the ability to shift priorities when required;
Coo! rdinates with member, family, and caregivers to help resolve b! arriers to care
Successfully collaborates with member and family to assure comprehension of available resources;
Other duties as required
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Role Summary (Conducts Home Visits and Nursing Facility-Visits)
The Nurse is responsible for supporting the Medical Director and Director of Pre-Certification for Bravo Health. Responsibilities include assuring health care services are available to Bravo members in an appropriate cost-effective manner and delivery of those services to promote healthy outcomes.
This position starts out from home and works in the field in Baltimore and surrounding counties. Nurse Case Manager will travel to homes and nursing facilities.
Location: Baltimore, Maryland
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Requirements
Requirements:
Registered Nurse with 3 years experience in a Managed Care environment. Home Care, long-term care or skilled-nursing home experience preferred.
Acti! ve unrestricted RN licensure
Working knowledge of medical coding (CPT/ICD-9) and medical necessity criteria (e.g., InterQual, Highmark, Trail Blazer)
Computer Proficiency with Microsoft Office and ability to effectively type and use various computer programs
Preferred Requirements:
Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
Able to work in a dynamic, fast-paced team environment and to promote team concepts
Excellent typing and computer skills
Must be comfortable going in to members' homes and nursing facilities.
Must be flexible and able to make good clinical decisions
Hours: 8 a.m.-5:00 p.m. or 9 ! a.m.-5:00 p.m.-Mon-Fri.
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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: Sat, 27 Apr 2013 17:20:34 GMT
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