(RN) Pre Certification Nurse Home Care- HealthSpring (Philadelp job at Cigna in Philadelphia

Cigna is looking of (RN) Pre Certification Nurse Home Care- HealthSpring (Philadelp on Thu, 25 Apr 2013 23:25:56 GMT. Job Description Role Summary: The Pre-Certification Home Health Nurse is responsible for supporting the Medical Director and Director of Pre-Certification. 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. . Major Duties Responsibilities include collecting...

(RN) Pre Certification Nurse Home Care- HealthSpring (Philadelp

Location: Philadelphia Pennsylvania

Description: Cigna is looking of (RN) Pre Certification Nurse Home Care- HealthSpring (Philadelp right now, this job will be placed in Pennsylvania. More details about this job opportunity kindly read the description below. Job Description

Role Summary:
The Pre-Certification Home Health Nurse is responsible for supporting the Medical Direct! or and Director of Pre-Certification. 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. .

Major Duties

Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions for Home Health Services;

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;

Makes appropriate referrals to Case Management for coordination of physical and mental health community related services

Process approval and adverse clinical determinations; providing correspondence for members, contracted and non-contracted providers;

Initiate the letter of agreement pr! ocess, 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;

Coordinates with member, family, and caregivers to help resolve barriers to care;

Successfully collaborates with member and family to assure comprehension of available resources;

Other duties as required .

Requirements

Qualifications

Registered Nurse with 3-5yrs experience in a Managed Care environment.

Previous experience in a Home Health setting desired.

Valid Nursing License in the Bravo’s member areas or ability to obtain in a reasonable time period as established by the Director of Health Services or Medical Director.

Working knowledge of medical coding! (CPT/ICD-9) and medical necessity criteria (e.g., InterQual, Highmark, CMS Guidelines)

Knowledge, Skills, Abilities Required:
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

Computer Skills:
Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word. .
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Cigna.

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Thu, 25 Apr 2013 23:25:56 GMT

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