Pre-Service Care Coordinator - EviCore - Work at Home

The Cigna Group; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

The Cigna Group is seeking a Utilization Review Analyst to perform clinical reviews and operational processes for Post-Acute Care services. Candidates should possess a current nursing license and have at least 2 years of clinical experience. This full-time position offers flexibility in hours and a comprehensive benefits package including medical, dental, and 401(k) matching.

Benefits

Comprehensive benefits package

401(k) with match

Paid time off

Tuition reimbursement

Annual bonus eligibility

Qualifications

• 2+ years of clinical experience required.
• Experience in utilization management preferred.
• Home health, SNF, and/or rehab experience desired.

Responsibilities

• Perform clinical and operational processes related to utilization review.
• Review clinical records using evidence-based guidelines.
• Assist with coordination between providers and members.

Skills

Time-management

Communication

Critical-Thinking/Decision-making

Autonomy

Proficient in Microsoft Office

Education

Current unrestricted Registered Nurse or Licensed Practical Nurse licensure

Associate or Bachelor Degree in Nursing

Completion of LPN program

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft PowerPoint

Videoconferencing systems (e.g., WebEx)

Job description

The job profile for this position is Utilization Review Analyst, which is a Band 2 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees and strive to help our associates grow professionally before recruiting new talent to our open positions. If you think this position is right for you, we encourage you to apply!

Our people make all the difference in our success.

Responsibilities include but are not limited to:

• Perform clinical and operational processes related to utilization review of pre-service and retrospective requests for Post-Acute Care services including long term acute care, skilled nursing, and inpatient rehab facilities.
• Review clinical records using evidence-based guidelines, ensure accurate and timely documentation, and communicate with healthcare providers and Medical Directors throughout the utilization review process.
• Assist with coordination between providers and members.

Minimum Education, Licensure, and Certification Requirements:

• Current unrestricted Registered Nurse or Licensed Practical Nurse licensure.
• Associate degree or Bachelor Degree in Nursing preferred; completion of LPN program preferred.
• Multistate license preferred.

Minimum Experience Required:

• 2+ years of clinical experience.
• 2+ years' experience in utilization management preferred.
• Home health, SNF, and/or rehab experience desired.
• Medicare/Medicaid managed care programs preferred.

Position is telephonic/Work at Home. Hours: Monday - Friday; 9 am - 6 pm Central Time Zone; full-time during core business hours with shift flexibility between 7 am and 7 pm CST. Availability for weekend, on-call, and holiday rotations. Ability to sit at a desk 50% of the time, use computer and phone, and perform reliable work schedule is essential.

Required Skills:

• Time-management: Effectively manage time and resources to complete work efficiently. Excellent organizational skills.
• Communication: Provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership.
• Critical-Thinking/Decision-making: Identify issues and develop appropriate solutions.
• Autonomy: Work independently with minimal supervision.
• Proficient in Microsoft Word, Excel, Outlook, PowerPoint; typing speed of 30 wpm preferred.
• Experience with videoconferencing systems like WebEx.

If working remotely, internet must be via cable broadband or fiber with speeds of at least 10 Mbps download and 5 Mbps upload. The hourly rate is anticipated to be $27-$41, depending on experience and location, with eligibility for an annual bonus plan.

We offer a comprehensive benefits package including medical, vision, dental, well-being programs, 401(k) with match, paid life insurance, tuition reimbursement, at least 18 days of paid time off, and holidays. For details, visit Life at Cigna.

Qualified applicants will be considered regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, marital status, genetic info, public assistance, citizenship, or other protected characteristics.

Please ensure you meet our posting guidelines to be eligible for consideration. For policy details, visit the provided link. Qualified applicants with criminal histories will be considered consistent with applicable laws.