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Concurrent Review Care Coordinator

Remote · Morocco Full-time

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:

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