(RN) Utilization Management Health Services Manager-(Post-Acute occupation at Cigna in Nashville

Cigna is currently seeking to employ (RN) Utilization Management Health Services Manager-(Post-Acute on Thu, 29 Aug 2013 14:18:32 GMT. Job Description Responsible for assisting in the development, implementation and management of health services functions and in achieving department goals and objectives. Provides guidance and supervision to staff. May handle grievance and/or appeal process. May coordinate and manage utilization review function ensuring accurate and timely prior authorizations, concurrent and retrospective review...

(RN) Utilization Management Health Services Manager-(Post-Acute

Location: Nashville Tennessee

Description: Cigna is currently seeking to employ (RN) Utilization Management Health Services Manager-(Post-Acute right now, this occupation will be placed in Tennessee. More details about this occupation opportunity please read the description below. Job Description

Responsible for assisting in the development, implementation and management of health servi! ces functions and in achieving department goals and objectives. Provides guidance and supervision to staff. May handle grievance and/or appeal process. May coordinate and manage utilization review function ensuring accurate and timely prior authorizations, concurrent and retrospective review activity. May be responsible for increasing patient compliance through education to optimize heath and minimize complications and exacerbation. Responsible for process improvement implementation, quality initiatives, and daily operations of the department. Performs updates to policies and procedures that are compliant with CMS requirements and NCQA/URAC/CMS A / state Medicaid requirements. May audit and must comply with corporate, federal, and state policies, procedures, and confidentiality standards. Conducts analysis on department statistics and creates reports on the findings. May act as a liaison with internal departments, outside entities, including physicians, hospitals, health ca! re vendors, social service agencies, member advocates, and reg! ulatory agencies. Leads departmental meetings and cross departmental project .

Requirements

Minimum Requirements: Bachelor’s degree or certification in relevant practice areas. At least five years experience in managed care. For Clinical positions, at least six years of clinical experience.

Preferred Requirements: Master’s degree or in process of obtaining advanced degree. Active Registered Nurse (RN) license .
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Cigna.

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This occupation starts available on: Thu, 29 Aug 2013 14:18:32 GMT

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