Summary: The PAC Case Administrator is responsible for maintaining workflow activities for the HH/DME/HIT Network for inbound and outbound communications between eviCore Healthcare stakeholders and external hospitals, physicians and Post-Acute Care providers. The Care Coordination Case Administrator demonstrates complete understanding of how to research and resolve issues pertaining to the pre-certification of services as well as delivery of services and day-to-day operational concerns using defined processes. Demonstrates full understanding and ability to differentiate the Care Coordination processes across multiple states to ensure compliance with both Medicare and Medicaid guidelines by state regulations and commercial plans. They are responsible for communicating all state specific and national health care laws to external hospitals, physicians and Post-Acute Care providers including the appeals/reconsideration policies. Inbound and outbound communications tasks include coordination of inbound requests from hospitals, physicians and Post-Acute Care providers for pre and re-certification, status checks on existing cases, directing calls to internal departments, notification calls to hospitals and Post-Acute Care providers regarding incomplete pre-certification requests, as well as authorization approvals. In addition, this position is responsible for outbound calls to members, providers, physicians and hospitals to ensure member is receiving ordered/approved services. The Care Coordination Case Administrator is responsible for evaluating client trends to report and partner with the appropriate internal stakeholders in order to address and resolve through facilitation of communication between clients, providers, IT and other eviCore healthcare team members.
Minimum Education, Licensure and Professional Certification requirement:
Minimum Experience required (number of years necessary to perform role):
This position is not eligible to be performed in Colorado.
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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.