Concurrent Review Care Coordinator (Utilization Management)

Location: United States Work at Home; remote, full-time work during core business hours with shifts between 7:00 a.m. and 7:00 p.m. CST. Weekend, on-call, and holiday rotation may be required.

Salary: $31–$52 per hour, depending on experience and geographic location; annual bonus eligibility anticipated.

Company

Evernorth Health Services, a division of hirify.global, develops pharmacy, care, and benefit solutions designed to improve health outcomes and access to treatment.

What you will do

• Implement, evaluate, and coordinate individualized plans of care for assigned members.
• Conduct utilization and concurrent reviews using medical necessity criteria and regulatory requirements.
• Collaborate with providers, Medical Directors, and interdisciplinary teams on transitions of care.
• Identify gaps or deviations in care plans and intervene to support desired outcomes.
• Document clinical decisions, determinations, and communications accurately and promptly.
• Participate in meetings, audits, compliance activities, and quality improvement initiatives.

Requirements

• Current, unrestricted Registered Nurse license in the state of residence; a multistate license is preferred.
• At least 2 years of clinical nursing experience.
• Utilization management or care management experience is preferred.
• Associate or Bachelor’s degree in Nursing is preferred.
• Critical thinking, sound clinical decision-making, strong organization, and professional communication skills.
• Proficiency with Microsoft Office tools and virtual meeting platforms; ability to work independently with minimal supervision.

Nice to have

• Experience in home health, skilled nursing, rehabilitation, or managed care.
• Knowledge of Medicare and Medicaid managed care programs.
• Multistate nursing license.

Culture & Benefits

• Medical, vision, dental, well-being, and behavioral health benefits from the first day of employment.
• 401(k), company-paid life insurance, tuition reimbursement, paid holidays, and leaves of absence.
• At least 18 days of paid time off per year.
• Remote home-based work requires cable broadband or fiber internet with at least 10 Mbps download and 5 Mbps upload speeds.
• Ability to sit for extended periods and use computer and telephone equipment is required.