- 26002604
The Clinical Evaluator will:
- Assist with development, implementation and coordination of a comprehensive quality management/improvement program for the clinical personnel.
- Ensure compliance with internal and external requirements and ensure excellent customer service is provided.
- Track and document quality assurance performance for clinical personnel of multiple specialties and incorporate results of call monitoring evaluations to develop training, continuing education, coaching, or other needs to ensure excellent customer service and experience.
- Collaborate with the Medical Management team to identify performance issues and implement quality improvement measures on issues identified.
- Assist with other duties as necessary.
Minimum Education, Licensure and Professional Certification Requirement:
- Associate Degree or Bachelor Degree in Nursing; LPN Certification
- Registered Nurse or LPN required.
- Must possess a valid RN or LPN license in state of primary residence.
Qualifications:
- Minimum 2 years relative work experience in a clinical and or clinical quality role required. Quality Assurance experience preferred.
- Minimum of one year of EviCore experience strongly preferred.
- Knowledge of Image One/CDP/Isaac preferred. EP is a plus.
- Knowledge of Managed Care/Medicare/Medicare Advantage preferred.
- Must demonstrate proficiency in use of Microsoft Office and Excel applications.
- Knowledge of quality assurance programs related to call centers preferred
- Ability to effectively manage one’s time and resources to ensure that work is completed efficiently.
- Ability to provide clear verbal and written information via in-person, email, and phone to co-workers and leadership.
- Ability to choose a course of action or develop appropriate solutions by identifying and understanding issues, problems, and opportunities.
- Ability to work independently. Intermediate computer literacy skills with ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint
- Knowledge of multiple specialties is strongly preferred.
- Hours: Monday – Friday; 8:00 am to 5:00 pm
- Work is Remote
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 25 – 38 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.
At The Cigna Group, 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), 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, click here.
About Evernorth Health Services
Evernorth 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 need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
