Senior Clinical Reviewer Analyst
The Cigna Group
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $31 - $52 per hour
Job Level
About the role
- 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.
Requirements
- Registered Nurse (RN) with multistate license in good standing.
- BSN preferred; Minimum 3 years RN experience in managed care, UM, or prior authorization.
- 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.
Benefits
- medical, vision, dental, and 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
- paid holidays
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementmedical necessity reviewclinical judgmentcase managementquality auditsperformance metricsdocumentation accuracy
Soft Skills
analytical skillscommunication skillsdecision-making skillstime managementadaptability
Certifications
Registered Nurse (RN)BSN