Quality Clinical Evaluator (Analyst) - EviCore-Work at Home
About The Position
The Clinical Evaluator will assist with the development, implementation, and coordination of a comprehensive quality management/improvement program for clinical personnel. This role ensures compliance with internal and external requirements and aims to provide excellent customer service. Responsibilities include tracking and documenting quality assurance performance for clinical personnel across multiple specialties, using call monitoring evaluations to develop training, continuing education, coaching, or other necessary interventions. The evaluator will also collaborate with the Medical Management team to identify performance issues and implement quality improvement measures. The Cigna Group, through its division Evernorth Health Services, is dedicated to improving the health and vitality of those they serve by creating pharmacy, care, and benefit solutions.
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
- Minimum 2 years relative work experience in a clinical and or clinical quality role
- Proficiency in use of Microsoft Office and Excel applications
- 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
Nice To Haves
- 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
- Knowledge of quality assurance programs related to call centers preferred
- Knowledge of multiple specialties is strongly preferred
Responsibilities
- 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
Benefits
- comprehensive range of benefits
- medical
- vision
- dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- minimum of 18 days of paid time off per year
- paid holidays
- annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
