Cigna After Hours Case Manager Specialist - 12% Shift Differential in Plano, Texas
Provide crisis triage support and utilization management for CIGNA Behavioral Health customers.
Shift: Fridays 11:30am -9:30pm, Sat and Sun 9:30am - 7:30pm, Mon 11:30am -9pm CST
This position qualifies for a 12% shift differential
Assists customers or their family members struggling with mental health or chemical health issues by assessing for their immediate needs and risks and assisting the customers to get access to the care they need. This includes the assessment of the bio-psycho-social needs of the member and connecting them to the appropriate community resources.
Obtains clinical assessment data from providers and recommends initial treatment authorizations (inpatient or outpatient) based on parameters from CIGNA LEVEL OF CARE GUIDELINES FOR MENTAL HEALTH AND SUBSTANCE ABUSE.
Provides information resources to clients, family members, and providers on an as-needed basis. To assist with problem solving or clarifying aspects of their mental health system (e.g. benefits, claims, procedures).
Provides Employee Assistance services to customers and client employers in the form of telephonic consultations, management consultations, and coordination of critical incident debriefings.
Reviews clinical status and therapeutic progress of clients with providers periodically to determine the need for continuing treatment; recommends authorization for continuing treatment as appropriate. Negotiates alternative session frequency or intervention strategy with providers when provider’s plan exceeds outpatient parameters of CIGNA LEVEL OF CARE GUIDELINES FOR MENTAL HEALTH AND SUBSTANCE ABUSE.
Creates and maintains computerized authorization and clinical records on each client by entering crisis notes, complete assessment, clinical update and authorization data for each customer and provider contact. Generates additional external correspondence (e.g. denial letters, uncooperative provider letters, etc.), as appropriate.
Contributes to team meetings in a manner which improves communications and procedures
relevant to team functioning. Also communicates with E.D., National Service Center personnel and external resources in a manner which facilitates effective system functioning and problem resolution.
Performs additional tasks as needed, requested or assigned.
Masters or PhD level clinical/counseling license (LMHC, LCSW, LMFT, LPCC, LPC, RN, or LP).
At least five (5) years of outpatient/inpatient experience as a mental health clinician involving knowledge in both mental health and substance abuse diagnosis and treatment preferred.
Knowledge/experience in coordinating alternative care treatments and community resources.
Position requires significant skill levels in both clinical judgment and interpersonal communication. Considerable diplomacy/tact is often required as customers and providers are not always receptive to the process. Clinical creativity is central to the process of developing alternative intervention strategies.
Primary Location: Eden Prairie-Minnesota
Other Locations: United States-Missouri-St Louis, United States-Arizona-Phoenix, United States-Texas-Plano
Work Locations: 11095 Viking Dr Eden Prairie 55344
Job: Med Mgt--Case Management
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Evening Job
Job Posting: Oct 10, 2018, 3:54:20 PM
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com