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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.

Compliance Statement

This job description is intended to comply with The Cigna Group Job Description Requirements and applicable employment, accreditation, and regulatory standards. Duties and responsibilities may be adjusted to meet business needs.

Compensation

For this position, we anticipate offering an hourly rate of 31 - 52 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.

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, and dental programs
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year and paid holidays

Equal Opportunity Statement

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.