Concurrent Review Care Coordinator - EviCore - Work At Home

Cigna Healthcare

20h•Remote

About The Position

The UM Clinical Reviewer Senior Analyst is responsible for concurrent review, care coordination, and utilization management activities across post-acute care settings. The role applies clinical judgment, evidence-based guidelines, and organizational policies to support quality outcomes, cost-effective care, and member experience. Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. They relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. The Cigna Group is dedicated to improving the health and vitality of those they serve through its divisions Cigna Healthcare and Evernorth Health Services.

Requirements

Current, unrestricted Registered Nurse (RN) license in state of residence
Minimum of 2 years of clinical nursing experience
Strong time management and organizational skills
Clear and professional written and verbal communication abilities
Critical thinking and sound clinical decision-making
Ability to work independently with minimal supervision
Proficiency with Microsoft Office tools (Word, Excel, Outlook, PowerPoint) and virtual meeting platforms
Internet connection obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload

Nice To Haves

Multistate license preferred
Associate or Bachelor’s degree in Nursing preferred
At least 2 years of utilization management or care management experience preferred
Experience in home health, skilled nursing, rehabilitation, or managed care environments preferred
Knowledge of Medicare and Medicaid managed care programs preferred

Responsibilities

Implement, evaluate, and coordinate individualized plans of care for assigned members.
Conduct utilization and concurrent reviews in alignment with medical necessity criteria and regulatory requirements.
Collaborate with providers, Medical Directors, and interdisciplinary teams to support transitions of care.
Identify gaps or deviations in care plans and intervene appropriately to support desired outcomes.
Document clinical decisions, determinations, and communications accurately and timely in designated systems.
Ensure compliance with The Cigna Group policies, accreditation standards, and confidentiality requirements.
Participate in meetings, audits, and quality improvement initiatives as assigned.