Utilization Review Nurse Salary in Philadelphia, PA

Public Health Ambassador - Temporary PositionUniversity OverviewThe University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy League school consistently ranks among the top 10 universities in the annual U.S. News & World Report survey. Penn has 12 highly-regarded schools that provide opportunities for undergraduate, graduate and continuing education, all influenced by Penn's distinctive interdisciplinary approach to scholarship and learning. As an employer Penn has been ranked nationally on many occasions with the most recent award from Forbes who named Penn one of America's Best Employers By State in 2021.Penn offers a unique working environment within the city of Philadelphia. The University is situated on a beautiful urban campus, with easy access to a range of educational, cultural, and recreational activities. With its historical significance and landmarks, lively cultural offerings, and wide variety of atmospheres, Philadelphia is the perfect place to call home for work and play.COVID-19 vaccination is a requirement for all positions at the University of Pennsylvania. New hires are expected to be fully vaccinated before beginning work at the University. For more information about Penn's vaccine requirements and the use of Penn Open Pass, visit the Penn COVID-19 Response website for the latest information. Posted Job TitlePublic Health Ambassador - Temporary PositionJob Profile TitleTemporary Employee - Non-ExemptJob Description SummaryThe Public Health Ambassador (PHA) program is a group of Penn community members committed to helping ensure our University community is following safety protocols and has access to the most current covid-19 related information to inform decision-making. The role of a PHA includes opportunities to recognize and reward healthy behaviors and ensure campus is properly “covered” with masks and PPE supplies and adequate testing. Public Health Ambassadors may be staffed in buildings helping to check PennOpen Passes, may roam campus distributing PPE supplies or positively re-enforcing good behavior, engage with our University City and West Philadelphia neighbors to ensure our students living in our broader Penn Community have access to PPE and information, and adequately support the University Testing Sites.Job DescriptionThis is a temporary position.There are three main PHA functions: the rover, building staff, and University's Testing Sites support. Rovers walk around on campus and enter specified buildings handing out masks if needed, enforcing school/center-specific policy, and reminding students, faculty and staff to keep up the good work in performing protective measures. Building staff are located on-site in school and center entrances ensuring entrants have a valid green OpenPass that matches their Penn ID. University's Testing Sites will need staff to support planned operations that are not specifically clinical in nature. These positions will require engagement with student participants and utilization of PPE to reduce opportunities for spread of any potential infection. The campus testing locations will be utilized to observe asymptomatic screening tests of all students. A saliva platform will be utilized which will reduce opportunities for close contacts with students. PPE will be necessary for two roles to manage infection control opportunities associated with incidental contact with saliva. Responsibilities will include:Queue Management - These individuals will greet participants, answer questions, enforce social distancing requirements while participants are waiting to enter the testing area. This position will answer questions about the process and how to obtain their results. No special PPE will be required other than a mask.Check In - These individuals will direct participants to tap a Penn card to check into their appointment and direct them to the next spot in the testing process. This position will answer questions about the process and how to obtain their results. No special PPE will be required other than a mask.Observers - These individuals will review the saliva gathering process and how to wipe and close the container. This role will direct the participant to stand in a specific area and reinforce social distancing requirements. This role will also direct students to the final process at check out and remind participants to dispose wipes appropriately. Observers will also float within the tent to answer questions and reinforce behavior. These individuals will wear appropriate PPE including gown, gloves, goggles and a mask.Check Out - These individuals will take the sample from the participant, wipe it down with an alcohol wipe and put it into a rack. They will remind participants to use hand sanitizer before exiting the testing area. This position will also remind participants to schedule their next appointment and where to check for results. These individuals will wear appropriate PPE including a gown, gloves, goggles and a mask.QUALIFICATIONS: High School Degree required. No specific previous experience is required. All positions require a strong level of engagement with students and other participants. Staff will receive training on COVID101 (Director of Campus Health and Chief Wellness Officer), de-escalation and safety training (Department of Public Safety), and conflict resolution (Office of Student Affairs). Hand hygiene and appropriate disposal of contaminated wipes will be essential in all positions. Proper PPE will be provided. Must use PennOpen Pass daily. Communication with site management is expected. Schedules will vary 6:00AM-11PM Sunday-Saturday, Nights and Weekends expected.PAY RATE:$20/hourJob Location - City, StatePhiladelphia, PennsylvaniaDepartment / SchoolHealth and WellnessPay Range$7.25 - $155.75Affirmative Action Statement Penn adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, or any other legally protected class.Special Requirements Background check may be required after a conditional job offer is made. Consideration of the background check will be tailored to the requirements of the job.To apply, visit https://wd1.myworkdaysite.com/en-US/recruiting/upenn/careers-at-penn/job/3535-Market/Public-Health-Ambassador---Temporary-Position_JR00039036Copyright ©2021 Jobelephant.com Inc. All rights reserved.Posted by the FREE value-added recruitment advertising agency jeid-335f67abd7f1a64384cbc4616c0566ce

University OverviewThe University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy League school consistently ranks among the top 10 universities in the annual U.S. News & World Report survey. Penn has 12 highly-regarded schools that provide opportunities for undergraduate, graduate and continuing education, all influenced by Penn's distinctive interdisciplinary approach to scholarship and learning. As an employer Penn has been ranked nationally on many occasions with the most recent award from Forbes who named Penn one of America's Best Large Employers in 2023.Penn offers a unique working environment within the city of Philadelphia. The University is situated on a beautiful urban campus, with easy access to a range of educational, cultural, and recreational activities. With its historical significance and landmarks, lively cultural offerings, and wide variety of atmospheres, Philadelphia is the perfect place to call home for work and play.The University offers a competitive benefits package that includes excellent healthcare and tuition benefits for employees and their families, generous retirement benefits, a wide variety of professional development opportunities, supportive work and family benefits, a wealth of health and wellness programs and resources, and much more.Posted Job TitleAssociate Director of Investigator-Initiated Research (Department of Cardiovascular Medicine)Job Profile TitleAssociate Director E, ResearchJob Description SummaryTo support the continued growth and expansion of the Division of Cardiology's Clinical Research Unit (CCRU), this position is responsible for assisting the Director with project development and oversight, staff management, and operational effectiveness of the unit. The candidate will assist in managing relationships between physicians, sponsors, other academic centers, CCRU staff and departmental director of fiscal operations. Specifically, candidate will assist in all operational planning relating to the research activities and ensure optimal communication across stakeholders. The Associate Director will assist with grant development, participate in facility and contractual issues and will participate in budget development and management. Responsibilities will also include providing regulatory support and oversight for investigator-initiated research studies across Cardiology and for promoting ethical research practice, educating/mentoring project managers and research coordinators, and advising faculty and trainee investigators engaging in any new clinical research (including protocol development, anticipating IRB review and concerns connected to patient safety and addressing prior to review, etc.). In close collaboration with the CCRU Director, this individual will design, implement and oversee data quality and monitoring plans. This individual will play a central role in expanding CCRU activities to affiliated practices beyond HUP and PCAM including collaborations and coordination with other Penn Medicine practices and with other institutions.Job DescriptionJob ResponsibilitiesAssist with scientific writing and grant development, participate in facility and contractual issues and will participate in budget development and management.Design and implement logistics for investigator-initiated trials; review and initiate clinical trials in conjunction with investigators and staff; implement general and trial-specific strategies that assure effective enrollment and optimal data quality; Develop and implement project tracking and reporting processesMeasure and report on metrics established for efficient process planning and financial management for assigned projects implementing innovative approaches to further grow and expand the unit with successful research collaborations and projects. Attend research-focused meetings of Cardiology subdivisions; expand and coordinate Cardiology clinical research beyond HUP and PCAMRecruit, onboard, and manage growing team clinical CCRU staff including research nurses, project managers, coordinators and assistants.Promote application of best-practices and efficient resource utilization across CCRU subdivisions other research-focused entities; Other duties and responsibilities as assignedQualificationsBachelor of Science, Bachelor of Arts, and 7 to 11 years of experience or equivalent combination of education and experience is required. Master's Degree and 7 to 10 years of experience preferred. This position is contingent upon grant fundingJob Location - City, StatePhiladelphia, PennsylvaniaDepartment / SchoolPerelman School of MedicinePay Range$74,476.00 - $125,000.00 Annual RateSalary offers are made based on the candidate's qualifications, experience, skills, and education as they directly relate to the requirements of the position, as well as internal and market factors and grade profile. Affirmative Action Statement Penn adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, or any other legally protected class.Special Requirements Background check required after a conditional job offer is made. Consideration of the background check will be tailored to the requirements of the job.University BenefitsHealth, Life, and Flexible Spending Accounts: Penn offers comprehensive medical, prescription, behavioral health, dental, vision, and life insurance benefits to protect you and your family's health and welfare. You can also use flexible spending accounts to pay for eligible health care and dependent care expenses with pre-tax dollars.Tuition: Take advantage of Penn's exceptional tuition benefits. You, your spouse, and your dependent children can get tuition assistance here at Penn. Your dependent children are also eligible for tuition assistance at other institutions.Retirement: Penn offers generous retirement plans to help you save for your future. Penn's Basic, Matching, and Supplemental retirement plans allow you to save for retirement on a pre-tax or Roth basis. Choose from a wide variety of investment options through TIAA and Vanguard.Time Away from Work: Penn provides you with a substantial amount of time away from work during the course of the year. This allows you to relax, take vacations, attend to personal affairs, recover from illness or injury, spend time with family-whatever your personal needs may be.Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility. If you apply when you're newly hired, you won't have to provide proof of good health or be subject to underwriting requirements. Eligible family members must always provide proof of good health and are subject to underwriting.Wellness and Work-life Resources: Penn is committed to supporting our faculty and staff as they balance the competing demands of work and personal life. That's why we offer a wide variety of programs and resources to help you care for your health, your family, and your work-life balance.Professional and Personal Development: Penn provides an array of resources to help you advance yourself personally and professionally.University Resources: As a member of the Penn community, you have access to a wide range of University resources as well as cultural and recreational activities. Take advantage of the University's libraries and athletic facilities, or visit our arboretum and art galleries. There's always something going on at Penn, whether it's a new exhibit at the Penn Museum, the latest music or theater presentation at the Annenberg Center, or the Penn Relays at Franklin Field to name just a few examples. As a member of the Penn community, you're right in the middle of the excitement-and you and your family can enjoy many of these activities for free.Discounts and Special Services: From arts and entertainment to transportation and mortgages, you'll find great deals for University faculty and staff. Not only do Penn arts and cultural centers and museums offer free and discounted admission and memberships to faculty and staff. You can also enjoy substantial savings on other goods and services such as new cars from Ford and General Motors, cellular phone service plans, movie tickets, and admission to theme parks.Flexible Work Hours: Flexible work options offer creative approaches for completing work while promoting balance between work and personal commitments. These approaches involve use of non-traditional work hours, locations, and/or job structures.Penn Home Ownership Services: Penn offers a forgivable loan for eligible employees interested in buying a home or currently residing in West Philadelphia, which can be used for closing costs or home improvements.Adoption Assistance: Penn will reimburse eligible employees on qualified expenses in connection with the legal adoption of an eligible child, such as travel or court fees, for up to two adoptions in your household.To learn more, please visit: https://www.hr.upenn.edu/PennHR/benefits-pay

Job SummaryThe RN Case Manager coordinates, manages and procures the discharge needs of patients identified as requiring post acute care services via initial admission screen, assessment and consults. This is achieved by collaboration with the family, the care team including physicians, nursing and other healthcare professionals. The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer. The Case Manager appeals 100% of all third party payer denials for acute care reimbursement according to the guidelines for the PA Region. The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.#STC QualificationsEducation Requirements4 year/Bachelor's DegreeExperienceRelevant ExperienceCertification and LicensurePA Registered Nurse LicenseRequired SkillsComputer Skills to include use and navigationExcellent Communications SkillsExcellent Interpersonal SkillsMicrosoft WordOverviewAbout St. Christopher's Hospital for ChildrenSt. Christopher's Hospital for Children, a partnership between Tower Health and Drexel University, is a 188-bed facility that provides exceptional care to children throughout the Greater Philadelphia area and surrounding counties.St. Christopher's has more than 220 pediatric experts on staff, combining top-notch pediatric care with a wide array of pediatric specialties including Cardiology, Ear, Nose and Throat, Gastroenterology, Oncology, and Orthopedics. It houses the only Verified Pediatric Burn Center between New York City and Baltimore and is one of only three Level I Pediatric Trauma Centers in Pennsylvania. St. Christopher's is a Magnet® designated hospital and was recognized as a Women's Choice Award Best Children's Hospital.In addition to its main location in Philadelphia, the hospital has a growing network of primary and specialty care locations throughout the Philadelphia suburbs and New Jersey so your child's health conditions can be treated close to home.About the Organization Tower Health, a regional healthcare system, serves communities across multiple counties in Pennsylvania. Its network includes Reading Hospital, Phoenixville Hospital, Pottstown Hospital, and St. Christopher's Hospital for Children (in partnership with Drexel University). Committed to academic medicine and training, Tower Health offers various programs, including residency and fellowship programs, the Drexel University College of Medicine at Tower Health, and the Reading Hospital School of Health Sciences. Additionally, the system provides a wide range of healthcare services, such as Reading Hospital Rehabilitation at Wyomissing, home healthcare via Tower Health at Home, TowerDirect ambulance and emergency response, Tower Health Medical Group, Tower Health Providers (a clinically integrated network), and Tower Health Urgent Care facilities across its service area.

Job SummaryThe RN Case Manager coordinates, manages and procures the discharge needs of patients identified as requiring post acute care services via initial admission screen, assessment and consults. This is achieved by collaboration with the family, the care team including physicians, nursing and other healthcare professionals. The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer. The Case Manager appeals 100% of all third party payer denials for acute care reimbursement according to the guidelines for the PA Region. The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.Schedule: Mon - Fri 8:30a - 5p OR Mon - Thurs 8a - 6:30p#STC QualificationsEducation Requirements4 year/Bachelor's DegreeExperienceRelevant ExperienceCertification and LicensurePA Registered Nurse LicenseRequired SkillsComputer Skills to include use and navigationExcellent Communications SkillsExcellent Interpersonal SkillsMicrosoft WordOverviewAbout St. Christopher's Hospital for ChildrenSt. Christopher's Hospital for Children, a partnership between Tower Health and Drexel University, is a 188-bed facility that provides exceptional care to children throughout the Greater Philadelphia area and surrounding counties.St. Christopher's has more than 220 pediatric experts on staff, combining top-notch pediatric care with a wide array of pediatric specialties including Cardiology, Ear, Nose and Throat, Gastroenterology, Oncology, and Orthopedics. It houses the only Verified Pediatric Burn Center between New York City and Baltimore and is one of only three Level I Pediatric Trauma Centers in Pennsylvania. St. Christopher's is a Magnet® designated hospital and was recognized as a Women's Choice Award Best Children's Hospital.In addition to its main location in Philadelphia, the hospital has a growing network of primary and specialty care locations throughout the Philadelphia suburbs and New Jersey so your child's health conditions can be treated close to home.About the Organization Tower Health, a regional healthcare system, serves communities across multiple counties in Pennsylvania. Its network includes Reading Hospital, Phoenixville Hospital, Pottstown Hospital, and St. Christopher's Hospital for Children (in partnership with Drexel University). Committed to academic medicine and training, Tower Health offers various programs, including residency and fellowship programs, the Drexel University College of Medicine at Tower Health, and the Reading Hospital School of Health Sciences. Additionally, the system provides a wide range of healthcare services, such as Reading Hospital Rehabilitation at Wyomissing, home healthcare via Tower Health at Home, TowerDirect ambulance and emergency response, Tower Health Medical Group, Tower Health Providers (a clinically integrated network), and Tower Health Urgent Care facilities across its service area.

Associate Director of Investigator-Initiated Research (Department of Cardiovascular Medicine)University OverviewThe University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy League school consistently ranks among the top 10 universities in the annual U.S. News & World Report survey. Penn has 12 highly-regarded schools that provide opportunities for undergraduate, graduate and continuing education, all influenced by Penn's distinctive interdisciplinary approach to scholarship and learning. As an employer Penn has been ranked nationally on many occasions with the most recent award from Forbes who named Penn one of America's Best Large Employers in 2023.Penn offers a unique working environment within the city of Philadelphia. The University is situated on a beautiful urban campus, with easy access to a range of educational, cultural, and recreational activities. With its historical significance and landmarks, lively cultural offerings, and wide variety of atmospheres, Philadelphia is the perfect place to call home for work and play.The University offers a competitive benefits package that includes excellent healthcare and tuition benefits for employees and their families, generous retirement benefits, a wide variety of professional development opportunities, supportive work and family benefits, a wealth of health and wellness programs and resources, and much more.Posted Job TitleAssociate Director of Investigator-Initiated Research (Department of Cardiovascular Medicine)Job Profile TitleAssociate Director E, ResearchJob Description SummaryTo support the continued growth and expansion of the Division of Cardiology's Clinical Research Unit (CCRU), this position is responsible for assisting the Director with project development and oversight, staff management, and operational effectiveness of the unit. The candidate will assist in managing relationships between physicians, sponsors, other academic centers, CCRU staff and departmental director of fiscal operations. Specifically, candidate will assist in all operational planning relating to the research activities and ensure optimal communication across stakeholders. The Associate Director will assist with grant development, participate in facility and contractual issues and will participate in budget development and management. Responsibilities will also include providing regulatory support and oversight for investigator-initiated research studies across Cardiology and for promoting ethical research practice, educating/mentoring project managers and research coordinators, and advising faculty and trainee investigators engaging in any new clinical research (including protocol development, anticipating IRB review and concerns connected to patient safety and addressing prior to review, etc.). In close collaboration with the CCRU Director, this individual will design, implement and oversee data quality and monitoring plans. This individual will play a central role in expanding CCRU activities to affiliated practices beyond HUP and PCAM including collaborations and coordination with other Penn Medicine practices and with other institutions.Job DescriptionJob ResponsibilitiesAssist with scientific writing and grant development, participate in facility and contractual issues and will participate in budget development and management.Design and implement logistics for investigator-initiated trials; review and initiate clinical trials in conjunction with investigators and staff; implement general and trial-specific strategies that assure effective enrollment and optimal data quality; Develop and implement project tracking and reporting processesMeasure and report on metrics established for efficient process planning and financial management for assigned projects implementing innovative approaches to further grow and expand the unit with successful research collaborations and projects. Attend research-focused meetings of Cardiology subdivisions; expand and coordinate Cardiology clinical research beyond HUP and PCAMRecruit, onboard, and manage growing team clinical CCRU staff including research nurses, project managers, coordinators and assistants.Promote application of best-practices and efficient resource utilization across CCRU subdivisions other research-focused entities; Other duties and responsibilities as assignedQualificationsBachelor of Science, Bachelor of Arts, and 7 to 11 years of experience or equivalent combination of education and experience is required. Master's Degree and 7 to 10 years of experience preferred. This position is contingent upon grant fundingJob Location - City, StatePhiladelphia, PennsylvaniaDepartment / SchoolPerelman School of MedicinePay Range$74,476.00 - $125,000.00 Annual RateSalary offers are made based on the candidate's qualifications, experience, skills, and education as they directly relate to the requirements of the position, as well as internal and market factors and grade profile. Affirmative Action Statement Penn adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, or any other legally protected class.Special Requirements Background check required after a conditional job offer is made. Consideration of the background check will be tailored to the requirements of the job.University BenefitsHealth, Life, and Flexible Spending Accounts: Penn offers comprehensive medical, prescription, behavioral health, dental, vision, and life insurance benefits to protect you and your family's health and welfare. You can also use flexible spending accounts to pay for eligible health care and dependent care expenses with pre-tax dollars.Tuition: Take advantage of Penn's exceptional tuition benefits. You, your spouse, and your dependent children can get tuition assistance here at Penn. Your dependent children are also eligible for tuition assistance at other institutions.Retirement: Penn offers generous retirement plans to help you save for your future. Penn's Basic, Matching, and Supplemental retirement plans allow you to save for retirement on a pre-tax or Roth basis. Choose from a wide variety of investment options through TIAA and Vanguard.Time Away from Work: Penn provides you with a substantial amount of time away from work during the course of the year. This allows you to relax, take vacations, attend to personal affairs, recover from illness or injury, spend time with family—whatever your personal needs may be.Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility. If you apply when you're newly hired, you won't have to provide proof of good health or be subject to underwriting requirements. Eligible family members must always provide proof of good health and are subject to underwriting.Wellness and Work-life Resources: Penn is committed to supporting our faculty and staff as they balance the competing demands of work and personal life. That's why we offer a wide variety of programs and resources to help you care for your health, your family, and your work-life balance.Professional and Personal Development: Penn provides an array of resources to help you advance yourself personally and professionally.University Resources: As a member of the Penn community, you have access to a wide range of University resources as well as cultural and recreational activities. Take advantage of the University's libraries and athletic facilities, or visit our arboretum and art galleries. There's always something going on at Penn, whether it's a new exhibit at the Penn Museum, the latest music or theater presentation at the Annenberg Center, or the Penn Relays at Franklin Field to name just a few examples. As a member of the Penn community, you're right in the middle of the excitement—and you and your family can enjoy many of these activities for free.Discounts and Special Services: From arts and entertainment to transportation and mortgages, you'll find great deals for University faculty and staff. Not only do Penn arts and cultural centers and museums offer free and discounted admission and memberships to faculty and staff. You can also enjoy substantial savings on other goods and services such as new cars from Ford and General Motors, cellular phone service plans, movie tickets, and admission to theme parks.Flexible Work Hours: Flexible work options offer creative approaches for completing work while promoting balance between work and personal commitments. These approaches involve use of non-traditional work hours, locations, and/or job structures.Penn Home Ownership Services: Penn offers a forgivable loan for eligible employees interested in buying a home or currently residing in West Philadelphia, which can be used for closing costs or home improvements.Adoption Assistance: Penn will reimburse eligible employees on qualified expenses in connection with the legal adoption of an eligible child, such as travel or court fees, for up to two adoptions in your household.​To learn more, please visit: https://www.hr.upenn.edu/PennHR/benefits-pay To apply, visit https://wd1.myworkdaysite.com/en-US/recruiting/upenn/careers-at-penn/job/Smilow-Center-for-Translational/Associate-Director-of-Investigator-Initiated-Research--Department-of-Cardiovascular-Medicine-_JR00082271Copyright ©2024 Jobelephant.com Inc. All rights reserved.Posted by the FREE value-added recruitment advertising agency jeid-19ceebe0644be44b9696533a828f26fd

Primary Function:Coordinate and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality -based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers.Responsibilities:Identifies gaps in needed quality metrics for customers and communicates to providerMaintains physical presence in participating provider practicesIdentifies high-risk/high-cost patients for possible case management intervention.Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development.Identifies customer needs, coordinates and supports planned and unplanned transitions and post discharge follow up calls which may include primary care physician and specialist appointment schedulingCollaborates with the attending physician to achieve identified patient outcomes.Attend and participate in weekly Complete Health Team roundsPerform telephonic outreach or home visits, as neededCommunicates with all departments to resolve issues or document trends.Understands and follows administrative guidelines (policy and procedure) of the unit.Attends and actively participates in staff meetings.Other Duties as assigned.Supervisory Responsibilities:NoneQualifications:Current Licensure as a registered nurse, in the state of residency. in good standing.Associates degree, diploma or B.S. in NursingThree to Five (3-5) years recent experience in an acute-care environment, case-management or utilization management position (experience can be a combination of LVN/RN licensure)Previous HEDIS and/or CMS STARs experience a plusBilingual - preferred Spanish both conversational and writtenJob Related Skills:Verbal and written communication skillsInterpersonal skillsBasic Mathematical and statistical abilityOrganizational skillsTyping and computer knowledge- able to type 35WPMKnowledge of utilization review requirements and proceduresKnowledge of current health care practices and appropriate treatments.Knowledge of community resourcesAbility to travel to and work at participating provider officesWorks independently with minimum of supervisionIf 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.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: [email protected] for support. Do not email [email protected] 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.