Case Manager - Utilisation Management
Greenock/Glasgow
Band 3
Purpose of the job/Key Objective:
The purpose of this role is to manage our healthcare and plan usage, maintaining
a high quality of patient care while seeking to provide cost containment by determining
the medical necessity and appropriates of setting and treatment.
Requirements of the role:
- Provide service delivery on assigned
products in a manner consistent
with established standard policies/procedures.
- Negotiate appropriate setting and duration of admission/treatment
with specialist and recording the outcome of said negotiation.
- Refer cases to the medical advisors if appropriate when criteria
is not met.
- Utilise established screening criteria to identify cases which
require more intensive review.
- Provide data entry of case information consistent with established
quality standards.
- Provide continuity of review for management of the utilisation
of care on each case.
- Handle some routine complaints if needed; securing supervisory
assistance with problem solving and decision making if required.
- Attain quality assurance standards.
- Establish and maintain communication with specialists, hospitals
and other providers of service.
- Work closely with customer service teams, hospital negotiator and
sales/account management.
Skills/experience:
- E, F or G grade RGN qualified
- Considerable post qualifications experience in varied clinical
environment
- Ability to adapt to computerised data system.
- Excellent verbal and written communication skills
- Excellent interpersonal skills
- Excellent time management
- Self motivated with a proactive approach
- Ability to make sound clinical decisions about patient care
- Ability to work independently
- Embracing change
- NMC registered
If you would like to apply for this position, please submit an application
in the form of a current CV and covering memo outlining your suitability for this role to Sarah.McIldowie@cigna.com, or
post your application to HR Department, CIGNA Healthcare, 1 Knowe Road, Greenock
, Scotland,
PA15 4RJ.