25 days old

Intake Lead Representative- Care Coordination Lead

Memphis, TN 38103
  • Job Code
Assists/collaborates with facilities, MD offices, and/or customers that require specialty drugs to meet an individual's healthcare needs and coordinate delivery of medication. Through communication and available resources, the Specialty Care Options (SCO) Care Coordination Lead will assist with non-clinical duties such as outreaching/collaborating with MD offices, confirming sites of care have all clinical information needed, enforcing buy/bill restriction guidelines, as appropriate, complete referrals, authorization entry, medical cost savings details, and limited customer/patient outreach.

This position services calls in a warm and empathetic manner as the calls can be sensitive in nature. Problem solving skills are critical to success within the role along with intelligent judgment of the caller's needs and collaborating with the RN for direction and intervention as necessary. Based upon the call type and requests, the Care Coordination Lead should be able to use customer service skills, knowledge of the SCO processes and Cigna training to effectively address caller's needs and/or issues/concerns. Incumbents will utilize telephonic communication, web based documentation and resources, and internal SCO materials to assist in achieving successful redirection and coordination. Collaboration and communication with the RN Case Manager, as needed, is critical to ensure timely coordination of redirection and customer needs. Time management skills are crucial.

Major Job Responsibilities and Required Results:

  • Establishes a collaborative relationship with the client, physician(s), and other providers to coordinate care.
  • Assist with enforcement/reinforcement of policies, guidelines, and/or benefit language with facilities, customers, and/or provider offices.
  • Documents findings in a clear concise manner
  • Acts as a liaison with the account, client/family, physician(s), internal and external matrix partners, and facilities/agencies, which may be done with the RN Case Manager, as appropriate.
  • Maintains accurate record (system) of interventions including cost/benefit analysis, savings, and data collection. Adheres to quality assurance standards and all case management policy and procedures.
  • Interacts with leadership, Medical Directors and/or SCO RN Case Managers as needed for direction and/or denial review.
  • The Specialty Care Options Care Coordination Lead interacts with Specialty Care Options Care Associates, benefit specialists, Pharmacy Service Center, Accredo Specialty Pharmacy and claims staff for claim payment direction to ensure correct interpretation of current and future cost of care.
  • Participates on committees, task forces and other company projects, as assigned.
  • Supports training initiatives or audits of case files, as assigned.
  • Demonstrates sensitivity to culturally diverse situations, clients and customers.
  • Ensures the member's privacy, confidentiality, and safety are maintained, adheres to ethical and accreditation standards, serves as a member advocate, and adheres to legal and regulatory standards.
  • Access the various Cigna systems to obtain requested information such as eligibility, benefits, demographic information, discharge and clinical information, available customer programs.
  • Any other assigned tasks as deemed necessary to meet business needs.

Minimum Requirements:

  • High School Diploma

Preferred Requirements
  • Excellent time management, organizational, research, analytical, and interpersonal skills.
  • Ability to communicate needs effectively to facilities, physicians' offices, and interdisciplinary team members.
  • Ability to meet deadlines, promote team concepts, manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments.
  • Ability to adapt to new workflows and tasks quickly.
  • Knowledge of the insurance industry and knowledge of claims processing and specialty pharmacy.
  • Effective listening and organizational skills.
  • Ability to manage multiple tasks, setting priorities where needed.
  • Ability to work independently, problem solve, and function without constant supervision.
  • Prior experience in managed care/healthcare environment ideal.
  • Excellent typing/computer skills with the ability to learn new computer software systems.
  • Strong telephonic communication skills.
  • Associate's degree or higher education.

This position is not eligible to be performed in Colorado.

About Cigna

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.

Posted: 2021-03-26 Expires: 2021-04-24
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Intake Lead Representative- Care Coordination Lead

Memphis, TN 38103

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