Senior Clinical Reviewer Analyst

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $31 - $52 / hour

⏰ Full Time

🟠 Senior

🔍🏥 Medical Reviewer

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 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 in a timely manner 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 • Internet connection through a cable broadband or fiber optic provider with at least 10Mbps download/5Mbps upload when working at home

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • 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 • Cable broadband or fiber optic internet connection requirement for work at home, with at least 10Mbps download/5Mbps upload