Performs peer review and case management activities. Delivers clinical expertise to the organization through peer review, decision making, training, management consultation as relates to care management. Works across all business lines and customers in making medical appropriateness and medical necessity decisions based on clinical protocols, scientific evidence, case information, and best clinical thinking. Helps to develop and shape clinical policy and procedures and assures that there is standardization across sites/teams on clinical practices.  

RESPONSIBILITIES INCLUDE:

Performs clinical and administrative peer review and appeals, case management, and case consultation activities.

Participates in inter-rater reliability testing and clinical guidelines training.

Serves as mentor/coach to Care Managers, Clinical Managers, Providers and other Peer Reviewers in clinical quality improvement process.

Acts as behavioral health consultant in areas of clinical expertise.

Improves provider relations through knowledgeable, evidence-driven peer review and positive collegial relationships.

Improves clinical outcomes through excellence of negotiation, education, and communication skills.

Model the solution-focused management style for all clinical staff in order to assure the most positive work force possible.

Develop clinical and administrative trainings that help to educate the clinical staff to Cigna’s Clinical Philosophy, new Clinical Work Flows, Clinical Theory and Application, and Accreditation standards.

Participates in Clinical Team staff meetings and trends issues in order to proactively determine if there are any training needs or work flow modifications. Follows-up on the determined needs.

Interface with Customers, Participants and/or Providers as needed to attend to clinical issues. In addition, model for staff the need to take into account the Customer, the provider, and/or the participant’s world view when making decisions and enhancements to service delivery.

QUALIFICATIONS:

Doctoral Degree in Psychology and BCBA or BCBA-D Certification.

Current unrestricted license to practice from a licensing agency within the United States.

At least 5 years of clinical experience post licensure.

2 plus years related supervisory/management experience gained in an appropriate clinical setting preferred.

Must exhibit strong leadership and sound decision making qualities.

Thorough knowledge of the principles and techniques of psychiatric, mental health/substance abuse diagnosis and treatment.

Experience with or exposure to managed care delivery and services.

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 annual salary of 103,000 - 171,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

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 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.

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.