Are you passionate about making a difference in the field of healthcare? Do you thrive in a fast-paced, dynamic environment where you can utilize your clinical knowledge and critical thinking skills? Cigna is seeking a highly motivated and compassionate individual to join our team as a Concurrent Review Care Coordinator. In this role, you will play a crucial part in ensuring the quality and efficiency of our members' healthcare by working closely with healthcare providers and care teams. We are looking for a qualified candidate with a strong clinical background, excellent communication skills, and a dedication to providing exceptional patient care. If this sounds like the opportunity for you, we encourage you to apply and join our mission to improve the health, well-being, and peace of mind of those we serve.
- Conduct concurrent reviews of medical records to determine the appropriateness and quality of care being provided to our members.
- Collaborate with healthcare providers and care teams to identify and address any gaps in care.
- Utilize clinical knowledge and critical thinking skills to make informed decisions about the medical necessity and effectiveness of treatments.
- Communicate with healthcare providers to obtain additional information and clarify any discrepancies in medical records.
- Monitor and track member progress and treatment plans to ensure timely and appropriate care is being provided.
- Identify potential risks and issues related to member care and escalate them to the appropriate parties.
- Educate and inform members and their families about their care options and help them navigate the healthcare system.
- Review and analyze data to identify opportunities for improvement in the delivery of care.
- Maintain accurate and detailed documentation of all reviews and communications.
- Adhere to all regulatory and compliance guidelines related to healthcare reviews and documentation.
- Continuously seek ways to improve processes and procedures to enhance the quality and efficiency of care coordination.
- Keep up-to-date with industry developments, best practices, and changes in healthcare policies and regulations.
- Foster positive relationships with healthcare providers and care teams to promote a collaborative approach to patient care.
- Participate in team meetings and trainings to share knowledge and expertise with colleagues.
- Demonstrate a strong commitment to providing exceptional patient care and promoting the mission and values of Cigna.
Bachelor's Degree In Nursing, Social Work, Or A Related Field
Minimum Of 2 Years Experience In A Clinical Setting, Preferably In Utilization Management Or Case Management
Knowledge Of Medicare And Medicaid Regulations And Guidelines
Excellent Communication And Interpersonal Skills To Effectively Collaborate With Healthcare Providers, Patients, And Insurance Company Representatives
Ability To Work Independently, Prioritize Tasks, And Make Decisions In A Fast-Paced Environment While Maintaining Accuracy And Attention To Detail.
Quality Assurance
Patient
Case management
Risk assessment
Utilization management
Medical coding
Care Coordination
prior authorization
Clinical Assessment
Claims Review
Healthcare Analytics
Provider Relations
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Attention to detail
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Concurrent Review Care Coordinator is $50,000 to $70,000 per year. This can vary depending on location, experience, and specific job duties. Some employers may also offer additional benefits and bonuses.
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Cigna Corp. provides medical, dental, disability, life and accident insurance and related products and services to businesses, governmental and non-governmental organizations and individuals. It operates through following segments: Global Health Care; Global Supplemental Benefits; Group Disability and Life; Other Operations; and Corporate.

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