Job Description
Role Description
- The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.
- 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.
- Qualifications
- Registered Nurse (RN) with multistate license in good standing.
- BSN preferred.
- Minimum 3 years RN experience in managed care, UM, or prior authorization preferred.
- Previous in-patient or outpatient experience preferred.
- 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.
- Requirements
- Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
- Hourly rate of 31 - 52 USD / hourly, depending on relevant factors, including experience and geographic location.
- Eligible to participate in an annual bonus plan.
- Benefits
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- 401(k) plan.
- Company paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year and paid holidays.
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