LVN or BSW Field Case Coordinator - Bedford, Texas job at Cigna in Bedford

Cigna is at present recruited LVN or BSW Field Case Coordinator - Bedford, Texas on Sun, 16 Feb 2014 18:23:42 GMT. Requirements: Must have current licensure as a Licensed Practical Nurse or Licensed Vocational Nurse with no restrictions or be a Masters degree Social Worker...

LVN or BSW Field Case Coordinator - Bedford, Texas

Location: Bedford Texas

Description: Cigna is at present recruited LVN or BSW Field Case Coordinator - Bedford, Texas right now, this job will be placed in Texas. More complete informations about this job opportunity kindly read the description below. Job Description

Responsibilities:
Responsible for the effective and sufficient support of all utilization management activities to include prospective/pre-certfication review of the outpatient medical services for medical necessity and appropriateness of setting according to established policies. Using an established set of criteria, evaluates and authorizes the medical necessity of outpatient services.

Evaluates cases for quality of care and documents quality issues, issues letter to provider if th! e service meets certification criteria, and escalates to manag! er or Medical Director for review if the service does not meet certification criteria, and may issue denial letters.

Responsible for steering members to in-network providers when possible.

Maintaining accurate system documentation and meeting documentation requirements established by department. Using multiple computer systems to complete their work.

Location: Travel throughout Tarrant County completing home assessments with members for personal attendant services (bathing, dressing, cleaning).

Requirements:
Must have current licensure as a Licensed Practical Nurse or Licensed Vocational Nurse with no restrictions or be a Masters degree Social Worker

Must have one year of utilization review experience plus three years clinical experience. Home health experience ideal.

Prefer managed care experience and knowledge of ICD-9, CPT coding, and Medicaid.

Good communication, organization and written sk! ills required.

Good interpersonal skills and team oriented.

Strong computer skills required with MS Office products.

Ability to work in a busy, high-volume environment. .
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Cigna.

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Sun, 16 Feb 2014 18:23:42 GMT

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