Job Description
- Job 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
- Requirements:
- 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 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
- Benefits:
- Health insurance
- Dental insurance
- Vision insurance
- 401(k)
- Company paid life insurance
- Tuition reimbursement
- Paid time off
- Paid holidays
- Wellness and behavioral health programs
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