Senior Clinical Reviewer Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $31 - $52 / hour

⏰ Full Time

🟠 Senior

🔍🏥 Medical Reviewer

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• 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 • Promote quality and cost-effective medical services through clinical review • Complete reviews timely to meet regulatory and contractual requirements • Represent Cigna professionally

🎯 Requirements

• Registered Nurse (RN) with multistate license in good standing • Compact license required • BSN preferred • Minimum 2 years RN experience in Cardiology, Oncology, ICU, or ER • 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 • Home internet connection through a cable broadband or fiber optic provider with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Work-at-home arrangement • Internet service requirement supported by cable broadband or fiber optic service

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