Cigna Care Senior Associate in Bedford, Texas


Position Summary:

The CareSr. Associate is responsible for supporting the SPW Administrative Team inBedford, TX which works closely with the various offices, staff, and Membershipacross Texas. This position will be responsible for the STAR PLUS Waiverprograms in Texas by collecting, interpreting and evaluating documentationprocessed for these various programs. The Care Sr. Associate will have aresponsible “alpha group,” or caseload, of Membership and work with the teamswithin the SPW Admin Team and Integrity Teams. The Care Sr. Associate will communicate with internal and externalcontacts regarding Member waiver status.

Essential Duties and Responsibilities:

  • Receive requests for upgrades, interest lists, Money Follows the Person, Medically Dependent Children Program; Meet and track turnaround times and quality review
  • Determine program requirements based on company policy, member benefit grid and any state documentation
  • Review Member requests and make determinations on correct
  • Maintain benchmark standards for TAT (Turnaround Time) as established by the organization.
  • Notifies responsible parties prior to initiation of denial or loss of Medicaid
  • Completes review of SC and Admin documentation
  • Proficient knowledge of departmental policies and procedures; knowledge of Medicaid, CFC, MMP, HIPAA;
  • Professional demeanor and the ability to work effectively within a team or independently;
  • Flexible with the ability to shift priorities when required;
  • Maintains regular and acceptable attendance at such level as is determined at the employer’s sole discretion
  • Other duties as requested


US Candidates Only : Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us


HighSchool Diploma or equivalent

Minimum1 year experience in a managed care environment preferred

Knowledge, Skills, Abilities Required:

  • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
  • Able to work in a dynamic, fast-paced team environment and to promote team concepts

Computer Skills:

Substantialknowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Exceland Word

Primary Location: Bedford-Texas

Work Locations: 2208 North Highway 121 STE 210 Bedford 76021

Job: Med Mgt--Utilization Mgmt

Schedule: Regular

Shift: Standard

Employee Status: Individual Contributor

Job Type: Full-time

Job Level: Day Job

Travel: No

Job Posting: Oct 13, 2016, 1:16:30 PM