[Hiring] Quality Clinical Evaluator (Analyst) @The Cigna Group

Role Description

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.

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.

Requirements

• 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.

Benefits

• Comprehensive range of health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) plan.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
• Hourly rate of 25 - 38 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.

Company Description

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.