Concurrent Review Care Coordinator - EviCore - Work At Home

Job description

Concurrent Review Care Coordinator Job Summary: The UM Clinical Reviewer Senior Analyst is responsible for concurrent review, care coordination, and utilization management activities across post-acute care settings. The role applies clinical judgment, evidence-based guidelines, and organizational policies to support quality outcomes, cost-effective care, and member experience. Key Responsibilities: Implement, evaluate, and coordinate individualized plans of care for assigned members. Conduct utilization and concurrent reviews in alignment 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 to support desired outcomes. 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. Education, Licensure & Certification: Current, unrestricted Registered Nurse (RN) license...