Cigna Medicare Behavioral Health Case Management Senior Analyst - Remote

Performs utilization management duties for Cigna Healthcare members following national and state clinical guidelines for inpatient and outpatient Medicare and Medicaid covered services. Participates in the discharge planning process and identifies appropriate resources both internal and external required for a successful transition of care to an alternative setting.
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Responsible for the effective and sufficient support of all behavioral utilization activities for several markets according to policies and procedures. Will focus on utilization management of Medicare and Medicaid covered Behavioral Health requests. Refers cases to the Medical Director as appropriate. Evaluates and refers cases to quality of care, disease management, and case management programs as needed. Assists with discharge planning. Maintains strong working relationship with internal and external customers. Professionally communicates information as needed or required. Documents information into the clinical management system. Supports the Cigna Healthcare Behavioral Health team providing data and identifying improvement opportunities.
Minimum Requirements: Current licensure as an LCSW, LMFT, LPC/LPCC, or RN with behavioral health experience, in the state of employment. At least three years clinical experience required and at least two years in utilization review preferred. Knowledge of ICD-10 and CPT coding guidelines. Familiarity in appropriately applying Level of Care Guidelines, including MCG Criteria, for utilization review.
Mon-Fri 8 am-5pm CST or Tues-Sat 8 am- 5 pm CST
Rotating holiday schedule
Weekend availability highly 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 54,700 - 91,100 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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.