Concurrent Review Care Coordinator

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• 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

🎯 Requirements

• Current, unrestricted Registered Nurse (RN) license in state of residence; multistate license preferred • Minimum of 2 years of clinical nursing experience • 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 • 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 • Availability for weekend, on-call, and holiday rotation may be required • Ability to sit for extended periods, utilize computer and telephone equipment, and perform occasional walking or standing

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home work