Pre-Service RN Care Coordinator - EviCore -Remote

Pre-Service RN Care Coordinator

Role Summary

The Pre-Service RN Care Coordinator supports clinical and operational activities for post-acute care services, including transition of care, care coordination, and case management. This position helps ensure members receive medically appropriate services and equipment ordered by their physician while supporting timely communication between members, providers, and internal partners.

Responsibilities

• Support clinical and operational processes related to transition of care, care coordination, and case management for post-acute care services, including home health, durable medical equipment, and related care management needs.
• Review physician-ordered services and equipment to help coordinate timely, appropriate member care.
• Collaborate with members, providers, caregivers, and internal teams to support continuity of care and resolve service coordination issues.
• Apply clinical judgment and established guidelines to support appropriate care coordination decisions.
• Document case activities accurately and timely in accordance with clinical, operational, regulatory, and compliance requirements.
• Maintain productivity, quality, and service expectations while managing assigned work in a remote environment.

Minimum Qualifications

• Active, unrestricted Registered Nurse license in state of residence.
• Minimum of 2 years of clinical RN experience.
• Ability to work Monday through Friday, 9:00 a.m. to 6:00 p.m. Central Time, with flexibility to work any shift between 7:00 a.m. and 7:00 p.m. Central Time based on business needs.
• Availability for weekend, on-call, and holiday rotation as business needs require.
• Ability to use a computer, telephone, and standard office equipment throughout the workday.
• Ability to maintain a dependable and reliable work schedule.

Preferred Qualifications

• Bachelor of Science in Nursing.
• Compact or multistate RN license.
• 2 or more years of utilization management experience.
• Experience in home health, skilled nursing facility, rehabilitation, post-acute care, or care coordination.
• Experience with Medicare and/or Medicaid managed care programs.

Work Environment

• This is a remote position.
• This role requires prolonged use of a computer, telephone, and other standard office equipment throughout the workday.
• This position may require sitting for extended periods, with occasional walking and standing.

Skills and Competencies

• Strong time management and organizational skills, with the ability to manage priorities and meet deadlines.
• Effective verbal and written communication skills with members, providers, coworkers, and leadership.
• Critical thinking and problem-solving skills, including the ability to evaluate information and determine appropriate next steps.
• Ability to work independently with minimal supervision while meeting performance expectations.
• Proficiency with Microsoft Word, Excel, Outlook, and PowerPoint.
• Experience using virtual collaboration tools such as Webex, Microsoft Teams, or similar platforms.
• Typing speed of 30 words per minute preferred.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we are dedicated to improving the health and vitality of those we serve. Through our divisions, Cigna Healthcare and Evernorth Health Services, we work to make health care more affordable, predictable, and simple for customers, clients, providers, and communities.

Equal Opportunity Employer

The Cigna Group is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.

 

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 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.

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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.