Provide comprehensive healthcare management to facilitate delivery of appropriate quality healthcare, promote cost effective outcomes and improve program/operational efficiency involving clinical issues.
Responsible for initial review and triage of Care Team tasks.
Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
Monitors non-targeted cases for entry of appropriate discharge date and disposition.
Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
Identifies triggers for referral into Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilizes eTUMS and other systems to build, research and enter member information, as needed.
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
Performs non-medical research pertinent to the establishment, maintenance and closure of open cases
Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
Adheres to Compliance with PM Policies and Regulatory Standards. Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
May assist in the research and resolution of claims payment issues. Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.
Goals & Objectives
Demonstrates values and behaviors in achieving business results
Meet or exceed productivity goals and supports overall UM TAT metrics
Meet or exceed productivity metrics-TBD
Management of task buckets/work lists/daily report or other tools to ensure timely handling of admissions in support of UM TATs:
Timely documentation of DRG Readmission, Late Notification, Non Par, and Eligibility/COB with triage of admissions to UM Nurses.
Assigns cases to the appropriate nurses in appropriate timeframe
Minimum UM Standards followed
Participates in personal development
Completes development plan by required date and tracks progress throughout the year in Talent | Reward.
Completes all mandatory trainings and weekly training updates by required completion date(s).
Embraces and contributes to achieving business excellence (ABX)
Promotes an efficient, positive and motivating workplace by embracing and/or advocating for necessary change.
Follows workflows as documented in the CH&S wiki for the appropriate program/process.
Maintains personal PTO/Attendance
Complies with attendance policies and procedures
Driving for Results (25% Common Scorecard Goal)
Holds self and others accountable for achieving best outcomes, drives enhanced value of health care to increase member satisfaction and retention, and drive new membership growth. Actions to support Goal:
Demonstrate empathy while addressing clinical issues with provider and members
Maintain clinician acumen by leveraging well-regarded medical references in order to stay current on clinical care and the regulatory environment.
Support Cognizant by serving as brand ambassador and supporting nurse talent attraction and retention.
Employee Status : Full Time Employee
Shift : Day Job
Travel : No
Job Posting : Apr 14 2020
Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 193 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @USJobsCognizant.Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network assists Veterans in building and growing a career at Cognizant that allows them to leverage the leadership, loyalty, integrity, and commitment to excellence instilled in them through participation in military service.
Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender, identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email CareersNA2@cognizant.com with your request and contact information.