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
• Perform concurrent review, care coordination, and utilization management across post-acute care settings
Requirements:
• Current, unrestricted Registered Nurse (RN) license in state of residence; multistate 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, 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
• Home internet connection through cable broadband or fiber optic service with speeds of at least 10Mbps download/5Mbps upload
Benefits:
• Annual bonus plan eligibility
• Medical, vision, and dental benefits starting on day one
• 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
• Remote work arrangement
• Flexible shift scheduling between 7:00 a.m. and 7:00 p.m. CST