Senior Clinical Reviewer Analyst

The Cigna Group

. Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage .

Posted 10/12/2026full-timeRemote • United StatesSenior💰 $31 - $52 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting utilization management reviews, applying medical policies, and maintaining compliance with regulatory standards. Proficient in case management and clinical judgment to promote quality medical services.

Highest-signal resume keywords

Registered Nurse (RN)Utilization ManagementCigna Medical PoliciesCase ManagementAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewClinical JudgmentDocumentation AccuracyPerformance MetricsRegulatory ComplianceQuality AuditsWorkflow ImprovementsCardiology ExperienceOncology ExperienceICU Experience

Soft Skills

Communication SkillsDecision-Making SkillsAdaptabilityTime ManagementTeam Collaboration

Tools & Technologies

Care Management PlatformsDocumentation SystemsWindowsMicrosoft Word

Certifications & Qualifications

Registered Nurse (RN) LicenseCompact LicenseBSN Preferred

Industry Keywords

MCGASAMURAC StandardsHIPAA ComplianceMedical Services

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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