The job profile for this position is Utilization Review Analyst, which is a Band 2 Senior Contributor Career Track Role.

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The goal of the Transition of Care Program is to manage the health plan member’s journey through the continuum of care from acute/post-acute care to home to ensure timely interventions aimed at reducing readmissions. Registered Nurse responsibilities include but not limited to:

Responsibilities:

• Perform Comprehensive health risk assessments to understand the member’s care coordination needs, risk factors, and gaps in care following discharge. This includes SDoH, and functional dimensions. Implement, evaluate, and coordinate the plan of care for all assigned patients.
• Perform medication reconciliation, evaluates adherence, and provides education.
• Review discharge summary with member and/or caregiver.
• Assist with PCP and Specialist follow-up appointment scheduling.
• Provide disease education.
• Telephonic position with the potential for In-Home visits as program evolves
• Care Coordination: e.g. DME needs
• Care summary- provide to PCP and health plan at conclusion of program to support transition

Minimum Education, Licensure and Professional Certification Requirements:

• Current unrestricted Registered Nurse licensure.
• Associate degree or Bachelor Degree in Nursing preferred
• Multistate license preferred

Minimum Experience Required:

• 2+ years of clinical experience
• 2 + years experience in utilization management preferred.
• Home health, SNF, and/or rehab experience desired
• Medicare/Medicaid managed care programs preferred
• Position is remote
• Hours: 8:00 am - 5:00 pm in the candidate's time zone.
• Availability for weekend rotation, on-call rotation, and holiday rotation.
• Ability to sit at a desk 50% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day; walking and standing.
• Ability to perform dependable and reliable work schedule is essential ••

Required Skills:

• Time-management: Ability to effectively manage one’s time and resources to ensure that work is completed efficiently Excellent organizational skills
• Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership
• Critical-Thinking/Decision-making: Ability to choose a course of action or develop appropriate solutions by identifying and understanding issues, problems, and opportunities
• Autonomy: Ability to work independently with little to no supervision
• Proficient in computer literacy skills with the ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint with the ability to type 30 wpm preferred
• Experience using videoconferencing systems such as WebEx

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 27 - 41 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.