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Company

Cigna Healthcare · 4 hours ago

Utilization Analyst ( LPN AND LVN)

United States

Contract

Remote

Entry, Mid Level

$25/hr - $25/hr

2+ years exp

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Hiring Manager

Alka Mathur

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Responsibilities

Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources.

Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.

Uses an established set of criteria to evaluates and authorize the medical necessity of services.

Provide notification of decisions in accordance with compliance guidelines.

Coordinate with Medical Directors when services do not meet criteria or require additional review.

Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.

Works with management team to achieve operational objectives and financial goals.

Supports teams across UM Department as needed.

Active participation and completion of all required trainings.

Maintain Required Licensures

Adherence to regulatory and departmental timeframes for review of requests

Meet/exceed department Turn Around time, daily established productivity goals, and service levels

Proficient knowledge of 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

Holiday rotation (2 holidays per year)

Weekend rotation

Other duties as required

Qualification

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LPN/LVN LicenseClinical ExperienceInsurance Industry KnowledgeMedical CodingCPT/HCPCS/ICD-10National Coverage DeterminationsLocal Coverage DeterminationsMCG CriteriaBasic Computer SkillsMicrosoft OfficeTime Management Skills

Required

Current, unrestricted LPN/LVN License in the state currently residing

Minimum of 2+ years clinical experience required

Strong customer orientation

Strong organizational, planning, and communication skills

Excellent time management skills

Proficient in basic computer skills

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.

Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.

Education: HS Diploma/GED & LVN/LPN License