Job Description
About the position
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.
- 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.
- Requirements
- Current, unrestricted Registered Nurse (RN) license in state of residence; multistate license preferred.
- Minimum of 2 years of clinical nursing experience.
- At least 2 years of utilization management or care management experience 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.
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
- Nice-to-haves
- Associate or Bachelor’s degree in Nursing preferred.
- Experience in home health, skilled nursing, rehabilitation, or managed care environments preferred.
- Knowledge of Medicare and Medicaid managed care programs preferred.
- Benefits
- At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
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