Quality Clinical Evaluator (Analyst) - EviCore-Work at Home

The Cigna Group

1d•Remote

About The Position

The Clinical Evaluator will assist with the development, implementation, and coordination of a comprehensive quality management/improvement program for clinical personnel, ensuring compliance with internal and external requirements and excellent customer service. This role involves tracking and documenting quality assurance performance for clinical personnel across multiple specialties, using call monitoring evaluations to develop training, continuing education, and coaching. The evaluator will also collaborate with the Medical Management team to identify performance issues and implement quality improvement measures. Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care, and benefit solutions to improve health and increase vitality, relentlessly innovating to make the prediction, prevention, and treatment of illness and disease more accessible.

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 required
Must demonstrate 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
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload

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.