Concurrent Review Care Coordinator

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Implement, evaluate, and coordinate individualized plans of care for assigned members • Conduct utilization and concurrent reviews aligned 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 • 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 RN license preferred • Associate or Bachelor’s degree in Nursing 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, and PowerPoint • Proficiency with virtual meeting platforms • Availability for weekend, on-call, and holiday rotation may be required • Ability to sit for extended periods and utilize computer and telephone equipment • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload if working at home

🏖️ 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 • Flexible shifts between 7:00 a.m. and 7:00 p.m. CST • Remote work / work from home • Cable broadband or fiber optic internet requirement with speeds of at least 10Mbps download/5Mbps upload