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