Role Description 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.

• 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.

Qualifications

• Current, unrestricted Registered Nurse (RN) license in state of residence; multistate license preferred.
• Associate or Bachelor’s degree in Nursing preferred.

Requirements

• 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.

Required Skills & Competencies

• 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.

Work Environment & Conditions

• This is a remote, full-time position during core business hours, with flexibility to work shifts between 7:00 a.m. and 7:00 p.m. CST.
• Availability for weekend, on-call, and holiday rotation may be required.
• The role requires the ability to sit for extended periods, utilize computer and telephone equipment, and perform occasional walking or standing.

Benefits

• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one.
• 401(k) and company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
• Hourly rate of 31 - 52 USD, depending on relevant factors, including experience and geographic location.
• Eligibility to participate in an annual bonus plan.