Clinical Reviewer - EviCore

Responsible for all clinical certification activities, which include but are not limited to evaluating telephone, fax, or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols, and authorizing services or referring requests for expert clinical review as appropriate. Reviews clinical information submitted by providers to appropriate criteria and standards and makes the decision to issue a review determination or to refer to physician review if criteria are not met. Maintains current departmental standards related to productivity. Trains in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures. Prepares program correspondence as needed. Serves as a resource for members calling for assistance. Makes outbound calls as required. Refers provider and member complaints, and appeals to appropriate departments. Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations. Provides outstanding customer service ensuring callers receive the highest possible service. Runs and analyzes report ensuring all tasks are completed in a timely fashion and meet regulatory requirements. Assists team members in departmental chats, by phone, and in person. Acts as a training assistant when assigned. Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed. Performs related duties as required.

Current, unrestricted license as an RN or LPN in state of a primary residence or appropriate compact state.
Must have at least 1 year of acute care, managed care, ER or ICU experience.
Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications.
Excellent communication skills both verbal and written; excellent problem solving and customer service skills are required.
Must be self-directed and highly motivated with an ability to multi-task. Excellent computer skills.
Must type at least 30 WPM. Must be able to hear and speak on the phone for an entire shift.

This position is not eligible to be performed in Colorado.

About Cigna
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.