Concurrent Review Care Coordinator

Job 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
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