UM Clinical Reviewer Senior Analyst - Allegiance - Work at Home

Cigna Healthcare•Tennessee Work at Home, TN

1d•$31 - $52•Remote

About The Position

The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review. The role applies Cigna clinical policies, national guidelines, decision-support tools, and clinical judgment to determine authorizations, ensuring reviews are completed on time to meet regulatory and contractual requirements while representing Cigna professionally. This work-at-home position requires a cable broadband or fiber-optic internet connection with speeds of at least 10 Mbps download and 5 Mbps upload. The anticipated hourly rate is $31–$52, depending on relevant factors such as experience and geographic location. The role is also anticipated to be eligible for an annual bonus plan. Cigna Healthcare, a division of The Cigna Group, advocates for better health through every stage of life and guides customers through the health care system. The company states that qualified applicants will be considered without regard to protected characteristics, and that reasonable accommodations are available for the online application process.

Requirements

Registered Nurse (RN) with a multistate license in good standing; a compact license is required.
At least 2 years of 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.
For work at home, an internet connection obtained through a cable broadband or fiber-optic internet service provider with at least 10 Mbps download and 5 Mbps upload speeds.

Nice To Haves

BSN preferred.

Responsibilities

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.