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Telephonic Registered Nurse Clinical Reviewer
The Cigna GroupTelephonic Registered Nurse Clinical Reviewer evaluating clinical service requests from providers. Authorizing services and maintaining productivity standards in a remote setting.
About the role
Key responsibilities & impact- Evaluating requests for authorization of clinical services from physician offices and/or imaging centers
- Comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review
- Reviewing clinical information submitted by providers and making decisions to issue a review determination
- Maintaining current departmental standards related to productivity
- Providing outstanding customer service ensuring callers receive the highest possible service
- Assisting team members with questions and participating in team meetings
Requirements
What you’ll need- Associates Degree in Nursing required
- Current, unrestricted license as an RN in state of primary residence
- Must have at least 1 year of acute care, managed care, ER, ICU experience or 2 years of clinical utilization management experience
- Excellent problem solving and customer service skills
- Ability to hear and speak on the phone for an entire shift
- Proficiency in MS Office applications
Benefits
Comp & perks- 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
- leaves of absence
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Clinical Protocol EvaluationReview DeterminationAuthorization of Clinical ServicesProductivity Standards MaintenanceClinical Information Review
Soft Skills
Problem SolvingTeam CollaborationCommunication Skills
Certifications
Associate's Degree in Nursing