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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