[Hiring] UM Clinical Reviewer Senior Analyst @Cigna Healthcare
Role Description
The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.
• Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage.
• Apply Cigna medical policies, MCG, ASAM, URAC standards, and clinical judgment.
• Identify cases requiring physician review and coordinate with Medical Directors.
• Initiate Case Management referrals as appropriate.
• Maintain compliance with HIPAA, regulatory rules, and internal quality standards.
• Participate in team meetings, quality audits, training, and workflow improvements.
• Support departmental initiatives, documentation accuracy, and performance metrics.
Qualifications
• Registered Nurse (RN) with multistate license in good standing.
• BSN preferred.
• Minimum 3 years RN experience in managed care, UM, or prior authorization preferred.
• Previous in-patient or outpatient experience preferred.
• Strong analytical, communication, and decision-making skills.
• Proficiency with Windows, Word, care management platforms, and documentation systems.
• Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment.
Requirements
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
• Hourly rate of 31 - 52 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) plan.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Apply tot his job
Apply To this Job
The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.
• Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage.
• Apply Cigna medical policies, MCG, ASAM, URAC standards, and clinical judgment.
• Identify cases requiring physician review and coordinate with Medical Directors.
• Initiate Case Management referrals as appropriate.
• Maintain compliance with HIPAA, regulatory rules, and internal quality standards.
• Participate in team meetings, quality audits, training, and workflow improvements.
• Support departmental initiatives, documentation accuracy, and performance metrics.
Qualifications
• Registered Nurse (RN) with multistate license in good standing.
• BSN preferred.
• Minimum 3 years RN experience in managed care, UM, or prior authorization preferred.
• Previous in-patient or outpatient experience preferred.
• Strong analytical, communication, and decision-making skills.
• Proficiency with Windows, Word, care management platforms, and documentation systems.
• Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment.
Requirements
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
• Hourly rate of 31 - 52 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) plan.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Apply tot his job
Apply To this Job