Concurrent Review Care Coordinator - EviCore - Work at Home

Cigna Healthcare•Tennessee Work at Home, TN

2d•$31 - $52•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. This is a remote, full-time position during core business hours, with flexibility to work shifts between 7:00 a.m. and 7:00 p.m. CST. Availability for weekend, on-call, and holiday rotation may be required. The role requires sitting for extended periods, using computer and telephone equipment, and occasional walking or standing. For home work, internet must be cable broadband or fiber with speeds of at least 10 Mbps download and 5 Mbps upload. The anticipated hourly rate is $31–$52, depending on relevant factors including experience and geographic location. The role is also anticipated to be eligible for an annual bonus plan. Benefits include medical, vision, dental, well-being and behavioral health programs, 401(k), company-paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, paid holidays, and leaves of absence. Duties may be adjusted to meet business needs.

Requirements

Current, unrestricted Registered Nurse (RN) license in the 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.
Ability to sit for extended periods, use computer and telephone equipment, and occasionally walk or stand.
For home work, access to cable broadband or fiber internet service with at least 10 Mbps download and 5 Mbps upload.

Nice To Haves

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

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.