Job Description

Position Scope:

• This is a Dedicated Client Specific Resource

Summary description of position:The role of the Clinical Liaison was developed for large clients with an accommodation model to provide effective clinical support to execute on programs and processes Cigna retains and to collaborate with external entities as delegated by the client for those it does not. Through coordination efforts and accommodation strategy, Cigna Healthcare will continue to deliver improved quality of health, increased affordability thru decreases in total medical costs and a positive customer and Health Care Professional experience.Goals are to prevent or minimize member exposure to medically unnecessary or avoidable hospitalizations; inappropriate delays in care, service or discharge planning and complications; to increase customer satisfaction and to maximize employer\xe2\x80\x99s health benefit resources. Collaboration and information sharing within permitted disclosures with external entities will result in specific actionable information sharing, increased value, and positive outcomes.Major responsibilities and desired results:

• Coordinate the delivery of health care services available to the aligned customers through a systematic process of customer identification, case review and collaboration in support of client aligned election.
• Primary clinical contact for client\xe2\x80\x99s external customer service and case management vendor.
• Build solid working relationships with internal and external partners.
• Interface and collaborate with internal and external partners to help facilitate timely and effective management.
• Monitor utilization management performed by Cigna and Cigna delegated vendor, which may include but not limited to the review of authorization reports, CenSys, Cigna systems, and delegated UM vendor systems for aligned client activity.
• Assess authorization and utilization trends to identify gaps, risks, complications, and/or barriers to optimal care.
• Perform case reviews to share actionable information on active patients with appropriate vendors
• Participate in scheduled meetings with external case management vendor.
• Participate in client meetings with manager/program support as indicated.
• Function as the clinical liaison between Cigna Healthcare and the external case management vendor to convey actionable information to and between internal and external partners.
• Identify integration opportunities for client specific trends, outlier conditions, problematic regions, and provide observations and recommendations to show improvement.
• Assist with case inquires to assist with complex cases, such as extended stays, high cost claimants, out of network, on shared customers to deliver actionable results and improve quality, cost, and outcomes.
• Coordinate referrals to and from the case management vendor as per agreement and established processes for the client.
• Maintain appropriate documentation and tracking as required by Cigna Healthcare.

• Educate matrix partners about programs available to customers via Cigna or external vendors, as per client elections.
• Participate in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Demonstrate sensitivity to culturally diverse situations, clients and customers.

Minimum requirements:Active unrestricted Registered Nurse (RN) license in state or territory of the United States Two years full-time equivalent of direct clinical care to the consumerPreferred requirements:

• Clinical experience in acute care, clinical setting, or case management setting
• URAC-recognized certification in case management within four (4) years of hire

Competencies preferred :

• Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
• Excellent written and oral communication skills are essential
• Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
• Knowledge of the insurance industry and claims processing
• Service marketing/sales and business acumen experience a plus
• Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
• Experience in medical management and case management in a managed care setting is highly desirable
• Knowledge of managed care products and strategies
• Demonstrated sensitivity to culturally diverse situations, participants and customers
• Ability to work within changing business environment and balance business needs with patient advocacy
• Experience managing multiple projects in a fast paced matrix driven environment
• Demonstrated ability to coach and educate other case management staff
• Demonstrate effective organizational skills and flexibility to meet the business needs

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 annual salary of 75,300 - 125,500 USD / yearly, 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\xe2\x80\x99s why you\xe2\x80\x99ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you\xe2\x80\x99ll 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 .About Evernorth Health ServicesEvernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.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.Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

The Cigna Group