Operating Effectiveness Senior Analyst- eviCore- Hybrid

Responsible for all aspects of Clinical Integration, including but not limited to: administration, clinical pathway development, CPT code management, denial language development activities, translating written criteria documents into an application using internally developed software, QA/testing for accuracy, monitoring feedback of users, and revising as required based on internal and external area feedback.
Minimum Requirements: Previous clinical experience preferred.
Demonstrated proficiency with Microsoft Office Applications (Word, Excel, Outlook a must) and medical terminology required (SQL preferred) Demonstrated potential and aptitude for working in the technology and the healthcare fields Experience with clinical pathways, software applications (Pathway Designer/UPADS preferred) and previous managed care experience preferred Analytical with strong verbal and written communication skills essential Responsibilities (include but not limited to): An understanding for utilization management, clinical review process, and call center operations Reviews and translates written criteria documents into operationally efficient rationale statements.
Structures relationships of data for optimal maintenance and preservation of resources Monitors feedback of users as appropriate Conduct QA of completed clinical integration processes prior to implementation Continuing education and training of language/NCQA rules regarding appropriate letter language output Collaborates with the Clinical Content team to stay abreast of policy/guideline changes that impact clinical output Documents and maintains tracking workflows Collaborate with Clinical Integration and Clinical Content personnel to ensure that system changes are loaded in a timely fashion Writing clinical text at varying degrees of language complexity across all lines of business Proficient in the updating and maintenance of Coverage Determinator tables to support clinical output and Compliance to regulatory standards Trains in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations 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 60,000 - 100,000 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.