Telephonic Registered Nurse Clinical Reviewer

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

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

• 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

• 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

• 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