Pre-Service Care Coordinator - EviCore - Work at Home

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The Registered Nurse or Licensed Practical Nurse responsibilities include but not limited to:

Perform clinical and operational processes related to utilization review of pre-service and retrospective requests for Post-Acute Care services including but not limited to long term acute care, skilled nursing and inpatient rehab facilities.
Responsible for reviewing the clinical record using evidenced-based guidelines, accurate and timely documentation and communication with health-care providers and Medical Directors for all assigned patients throughout the utilization review process.
Assist with the coordination between providers and members.

Minimum Education, Licensure and Professional Certification Requirements:

Current unrestricted Registered Nurse licensure 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; 9a-6p Central Time Zone; Position is full-time during core business hours with the ability to work any shift between 7 am and 7 pm CST.
Availability for weekend rotation, on-call rotation, and holiday rotation.
Ability to sit at a desk 50% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day; walking and standing.
Ability to perform dependable and reliable work schedule is essential.

Required Skills:

Time-management: Ability to effectively manage one’s time and resources to ensure that work is completed efficiently Excellent organizational skills
Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, and leadership
Critical-Thinking/Decision-making: Ability to choose a course of action or develop appropriate solutions by identifying and understanding issues, problems, and opportunities
Autonomy: Ability to work independently with little to no supervision
Proficient in computer literacy skills with the ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint with the ability to type 30 wpm preferred
Experience using videoconferencing systems such as WebEx

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.

For this position, we anticipate offering an hourly rate of 27 - 41 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Cigna Group Glassdoor Company Review

3.6

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CEO of The Cigna Group

David Cordani

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Average salary estimate

$70720 / YEARLY (est.)

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$56160K

$85280K

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What You Should Know About Pre-Service Care Coordinator - EviCore - Work at Home, The Cigna Group

Are you a motivated and compassionate nurse looking to make a difference from the comfort of your home? As a Pre-Service Care Coordinator with EviCore, you will take on a rewarding role that allows you to impact patient care directly. In this position, you'll be responsible for handling clinical and operational processes related to utilization reviews for various Post-Acute Care services. This could include long-term acute care and skilled nursing facilities. Your keen eye for detail will be crucial as you review clinical records against evidenced-based guidelines, ensuring timely documentation and effective communication with healthcare providers and Medical Directors. Ideally, you’ll have a current nursing license, either as a Registered Nurse (RN) or Licensed Practical Nurse (LPN), along with a couple of years of clinical experience. Previous utilization management experience is highly valued, and familiarity with home health or rehab environments will serve you well. The role operates Monday through Friday with a full-time schedule during core business hours, although flexibility for weekend and holiday rotations is required. Excellent time management, critical thinking, and communication skills are essential in this role, and your ability to work autonomously will be a great asset. EviCore offers not only a competitive hourly rate but also a comprehensive benefits package aimed at your overall well-being. Take this opportunity to enhance your career while making a positive impact on patients' lives—apply today!

Frequently Asked Questions (FAQs) for Pre-Service Care Coordinator - EviCore - Work at Home Role at The Cigna Group

What are the responsibilities of a Pre-Service Care Coordinator at EviCore?

As a Pre-Service Care Coordinator at EviCore, you'll be responsible for performing clinical and operational reviews related to pre-service and retrospective requests for various Post-Acute Care services. This involves critically analyzing clinical records against evidenced-based guidelines, ensuring accurate documentation, and maintaining effective communication with healthcare providers and Medical Directors throughout the utilization review process.