Behavioral Health Initial Clinical Examiner- Evernorth Health Services - Remote

This position is part of the Inpatient Utilization Management team.
The ideal candidate for this position is a licensed professional with a background in the insurance industry as a care manager in a behavioral healthcare role, or an individual who has worked in a mental health or chemical dependency treatment facility in the area of utilization management, or in direct provision of service as a mental health or chemical dependency counselor.
As an Inpatient Care Manager at Evernorth Health Services, you will use your clinical knowledge and skills to evaluate appropriate health care services and treatment plans in conjunction with inpatient providers. You will partner with facilities and families to identify and implement a holistic approach to treatment outcomes. You will be part of a virtual organization with multiple sites and must function well both independently as well as part of a larger team.
Responsibilities:
Perform precert and concurrent reviews using telephonic queue/warm transfer for inpatient levels (Detox, Inpatient, Residential, and Partial Hospitalization).
Collaborate with Facilities and Health Care Providers telephonically to obtain clinical information and ensure quality treatment outcomes in the least restrictive setting utilizing established Medical Necessity Criteria.
Coordinate with facilities to assist with discharge planning, aftercare follow-up appointments, and integration of services with Evernorth Health Services Medical and Pharmacy.
Engage with customers and families to understand needs, facilitate access to Evernorth Health Services coaching/case management programs and community resources.
Work in a team environment which includes contributing to team meetings, participating in clinical rounds with Evernorth Health Services Medical Directors for input on utilization management, and attending all required trainings impacting utilization review and accreditation procedures.
Manage own caseload and coordinate all assigned cases.
Perform additional tasks/projects as needed, requested or assigned.
Qualifications
Requires Master's degree mental health discipline and independent licensure to practice in the state of employment (LCSW, LMFT, LPC, LPCC, or Licensed Psychologist)
3 - 5 years post-license mental health experience preferred
Excellent communication and interpersonal skills with a focus on customer service
Effective conflict management and negotiation skills
Ability to adapt to change and problem solve
Strong time management and organization skills with an ability to set priorities in a fast paced environment
Ability to utilize and navigate multiple technology systems
Knowledge of managed care preferred
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 62,400 - 104,000 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’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 Group .
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
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.