Cigna Assistant Manager, Clinical Services in Kowloon, Hong Kong

Description:

The incumbent will be active in ensuring that medical decisions made will adhere to Cigna’s guidelines. He/she will perform pre-authorization services to ensure cost-effectiveness and appropriateness of treatment. This will enable Cigna HK to enhance its competitive position as a health and wellness provider as well as support our bottom line through improved claims outcomes. Case management involves pre-authorization, treatment monitoring and outcome assessment to achieve personal and company’s objective.

He/she will also provide service to internal and external customers responding to and resolving requests and queries via various communication channels – call, email and efax, etc., to assist in the planning, development, implementation and monitoring of Cigna Hong Kong’s health and wellbeing initiatives.

Key Responsibilities:

  • Liaise and coordinate with medical professionals, administrators of healthcare providers and customers to ensure the cost-effectiveness and appropriateness of the treatment.
  • Obtain authorization on all necessary visits and/or surgical procedures prior to the surgery and/or procedure.
  • Interface with physicians and medical staff to ensure all necessary documentation is valid and complete in a timely manner in order to obtain authorizations.
  • Provide advice and guidance to our claims team in the process of adjudicating claims.
  • Manage and track the performance of implemented programs.
  • Keep abreast of current wellness and wellbeing initiatives and develop a network of resources.
  • Explore ideas and opportunities to personalize the program to increase participation.
  • Conduct Medical pre-authorization in compliance with Cigna guidelines and to assess treatment plans following standard clinical protocols and evidence-based case guidelines.
  • Special projects as assigned

Qualifications:

  • Qualified Registered Nurse with 10 years or more clinical experience
  • Hold a valid practicing certificate and professional indemnity insurance
  • Strong research and medical knowledge (diagnosis, procedure) would be highly advantageous
  • Wellness and benefits experience preferred
  • Strong conceptual, strategic and visionary skills
  • Critical thinking skills
  • The ability to work with employees at all levels
  • Strong interpersonal communication and customer service skills with the ability to motivate others
  • The ability to work both independently and as a part of a team with enthusiasm, initiative and creativity
  • Excellent skills in all Microsoft Office Programs including Word, PowerPoint, Publisher and Excel
  • Ability to interpret data and translate findings into business opportunities
  • Ability to develop relationships across all levels of the Company, as well as externally
  • Excellent communication skills in both written and spoken English and Chinese

Primary Location: Kowloon-Hong Kong

Work Locations: 100 How Ming Street, Kwun Tong AXA Tower, Landmark East Kowloon

Job: Clinical--Nursing

Schedule: Regular

Shift: Standard

Employee Status: Individual Contributor

Job Type: Full-time

Job Level: Day Job

Travel:

Job Posting: Apr 12, 2018, 7:38:37 PM

Cigna is an equal opportunity employer, which means we offer equal treatment to all applicants. Cigna does not discriminate, either directly or indirectly, on the grounds of race, color, sex, gender identity, sexual orientation, nationality, national origin, ethnic origin, religion, beliefs or creed, age, disability, marital status, veteran status or genetic information in any area of recruitment. In some countries we ask for information on the ethnic origin, gender and disability of our applicants for the purpose of monitoring equal opportunity. If you have a disability and would like to indicate as part of your application any relevant effects of your disability and any adjustment which you consider should reasonably be made to the process to assist your application, please do so in the relevant field during the application process.